Tubercular Mastitis Mimicking as Malignancy: A Case Report

Tubercular mastitis is a rare form of extrapulmonary tuberculosis commonly seen in multiparous and lactating women in developing countries. It is a diagnostic challenge and commonly misdiagnosed as breast carcinoma. Tubercular mastitis is paucibacillary, and fine-needle aspiration cytology provides an accurate diagnosis - the presence of granulomas with Langerhans giant cells on histopathological examination warrants empirical treatment with anti-tubercular drugs. We report a case of a 31-year-old Indian female who consulted a local physician with chief complaints of a palpable, tender mass in her left breast, with pain, swelling, and purulent discharge past 15 days. The patient's past medical, surgical, medication history, and family history (concerning tuberculosis) were not significant. Initially, the patient suspected of breast malignancy based upon physical examination, mammography, and fine-needle aspiration cytology but an accurate diagnosis of tubercular mastitis made with repeated histopathological examination. Histopathologic examination of excised material showed granulomas composed of histocytes, Langerhans giant cells, and inflammatory cells. The patient underwent surgical drainage on the left breast and put on the anti-tubercular regimen for 6 months with her child also prescribed isoniazid for 6 months. The patient advised for regular follow-ups.