Primary MDR-TB of the breast

A 28-year-old, lactating lady presented to us with left-sided breast abscess and lymph node enlargement in the left axillary region for the past one and a half months. Investigations revealed the breast abscess and axillary lymphadenopathy were tubercular in origin. The patient was put on standard four-drug anti-tubercular treatment (rifampicin, isoniazid, ethambutol and pyrazinamide). The patient did not respond to the intensive four-drug therapy, which was continued for three months. The culture isolate of the breast abscess grew M. tuberculosis, which was resistant to isoniazid, rifampicin and streptomycin. The patient was then retreated with a regimen comprising--kanamycin, ofloxacin, ethionamide para-amino salicyclic acid (PAS), pyrazinamide and isoniazid, from which the patient benefited and recovered.