Tubercular breast abscess--a diagnostic dilemma

Tuberculosis affects many organs, however isolated tubercular breast lesion is rare. Clinically as well as radiologically it may mimic both pyogenic abscess and malignancy. One such case is being reported where a middle aged woman presented with painful, gradually increasing breast lump and was diagnosed clinically, radiologically, cytologically and even histologically as pyogenic abscess. Poor response to antibiotics raised the suspicion of malignancy for which repeat fine needle aspiration cytology was done. Well formed granulomas, necrosis and finally demonstration of acid fast bacilli established the diagnosis of tubercular abscess. No other organs were involved by tuberculosis in this case. Patient responded well to antitubercular drugs. Thus diagnostic challenge lies in the demonstration of acid fast bacilli in cases of equivocal morphology in routine cytology as well as histology. High clinical suspicion, poor response to antibiotics, suggestive radiological findings, cytology, histology and demonstration of acid fast bacilli -all contributes to the diagnosis of breast tuberculosis.