Breast tuberculosis in immunocompetent patients at tertiary care center: A case series
A 26-year-old female patient presented with recurrent left breast abscess with palpable lump and multiple discharging sinuses attended our outdoor clinic in January 2010. According to the patient, the lump had been present for the past 24 months when she had 7 months pregnancy, the patient was treated with anti tubercular drugs[] and after delivery she left antitubercular treatment (ATT) for 2 months then restarted again and completed full ATT regimens. Again, she developed sinuses in her left breast 6 months ago []. She had no past history of weight loss or fever and no history of breast malignancy or TB in her family. On physical examination, her weight was 45 kg. The left breast was very tender and diffused irregular mass was present, mainly involved the lower quadrants. Their overlying skin was discolored, with multiple sinuses discharging a dirty yellow colored fluid. On fine needle aspiration cytology (FNAC), smear disclosed aggregated of epithelioid histocytes occasional multi nucleated histiocytic giant cells, on an inflammatory background consisting of polymorphs, lymphocytes and some plasma cell along with fair number of squamous epithelial cells. Zeihl Neelsen (ZN) stain was positive for acid fast bacilli (AFB). Culture by Lowenstein-Jensen medium (LJ Medium) was negative for Mycobacteria after eight weeks incubation. Interferon gamma releases assay gave negative result at standard cutoff by manufacture.[] In view of again developed breast abscess with AFB, possibility of treatment failure was considered as relapse case restarted category II treatment under DOTS (Directly Observed Treatment Short Course). On three months follow-up, lymph node enlargement had regressed and abscess was resolved, though there was recurrence of small abscess after 1 month. Finally, she completed the treatment and was cured of TB infection.