Unusual Presentation of Tuberculosis: Diagnostic Challenges in Isolated Axillary Tuberculous Lymphadenitis

Tuberculosis (TB) is a communicable disease with high morbidity, significantly affecting quality of life. It has high prevalence in developing countries and is broadly categorized into pulmonary and extrapulmonary TB. The axillary lymph nodes are affected in around 3% of tuberculous lymphadenitis. However, isolated axillary TB lymphadenitis (without TB at other sites) is even rarer. It sometimes creates diagnostic difficulty, particularly in female patients, as even though the possibility of breast cancer presenting with only enlarged axillary lymph nodes (Occult Breast Cancer) is extremely rare (0.3%-0.8%), the possibility of other pathologies such as lymphoma, fungal infections, and sarcoidosis need to be ruled out. It is more common in females compared to males, and it commonly involves the left side. Chest X-ray and ultrasound, followed by computer tomography of the Chest and Axilla are useful primary investigations for the diagnosis. Excision Biopsy and Histopathological examination of the lymph node are the confirmatory tests. We hereby report a case of isolated axillary tuberculous lymphadenitis in a 66-year-old immunocompetent female.