Recurrent breast abscess leading to an incidental diagnosis of tuberculous mastitis: a case report

Breast abscesses are commonly seen in lactating and non-lactating women due to bacterial infections, often caused by Staphylococcus aureus. Recurrent abscesses pose a therapeutic challenge. Tuberculous mastitis (TM) is a rare but important differential diagnosis, often misdiagnosed as pyogenic abscesses or malignancies. Routine AFB staining and molecular testing are recommended for all atypical or recurring breast abscesses in endemic regions to rule out tuberculous mastitis.

We report a case of a 26-year-old Indian female presenting with recurrent right breast abscess. On local examination there was a 4 × 3 cm tender, fluctuant swelling in the upper outer quadrant of the right breast with erythema and raised temperature; no nipple retraction or axillary lymphadenopathy was noted. She denied systemic symptoms such as chronic cough, fever, night sweats, or unintended weight loss. The abscess was managed with incision and drainage followed by secondary suturing. Routine Ziehl-Neelsen staining of the pus revealed acid-fast bacilli (AFB), prompting cartridge-based nucleic acid amplification test (CBNAAT) and culture which confirmed Mycobacterium tuberculosis; Rapid Tuberculosis (TB) Ag MPT64 was also positive. Antitubercular therapy (ATT) was initiated as per national guidelines.

This case highlights the importance of considering tuberculous mastitis in recurrent or non-resolving breast abscesses, particularly in endemic settings. Early microbiological evaluation, including AFB staining and molecular assays, is essential for accurate diagnosis and timely initiation of anti-tuberculous therapy, thereby preventing repeated interventions and morbidity.