ISOLATED TUBERCULOUS MASTITIS: A DIAGNOSTIC CHALLENGE IN A YOUNG POSTPARTUM FEMALE

Abstract

Background: Tuberculous mastitis is a rare manifestation of extrapulmonary tuberculosis, accounting for less than 0.1% of all breast lesions in developed countries and approximately 3–4% of surgically treated breast diseases in tuberculosis-endemic regions. Primary isolated breast tuberculosis without evidence of pulmonary or disseminated disease is exceptionally uncommon. Owing to its nonspecific clinical and radiological presentation, it frequently mimics breast carcinoma or idiopathic granulomatous mastitis, posing a significant diagnostic challenge. Case Presentation: A 26-year-old lactating woman, eight months postpartum, presented with a gradually enlarging painful lump in the right breast of two weeks' duration. Clinical examination revealed a firm, mobile 2 × 1 cm retroareolar mass located at the 7–8 o'clock position without skin changes or axillary lymphadenopathy. Ultrasonography demonstrated a 2.2 × 1.4 cm heterogeneously isoechoic lesion with internal anechoic areas and was categorized as BI-RADS 4A. Fine-needle aspiration cytology demonstrated granulomatous mastitis. Owing to persistent clinical suspicion, the specimen was subjected to GeneXpert MTB/RIF testing, which confirmed Mycobacterium tuberculosis with rifampicin sensitivity. Chest radiography revealed no evidence of pulmonary tuberculosis, establishing the diagnosis of primary isolated tuberculous mastitis. The patient was treated with a nine-month anti-tubercular regimen (2 months of isoniazid, rifampicin, pyrazinamide, and ethambutol followed by 7 months of isoniazid and rifampicin). She achieved complete clinical and radiological resolution following completion of therapy. Discussion: Primary tuberculous mastitis remains a rare clinical entity despite the high prevalence of tuberculosis in endemic countries. The disease often masquerades as malignancy because neither clinical examination nor imaging reliably differentiates it from breast carcinoma. Histopathology demonstrating granulomatous inflammation should prompt microbiological confirmation, and molecular diagnostic techniques such as GeneXpert provide rapid and highly specific diagnosis. Early recognition enables timely medical therapy while avoiding unnecessary surgical procedures. Conclusion: Tuberculous mastitis should remain an important differential diagnosis in young lactating women presenting with suspicious breast masses in tuberculosis-endemic regions. A multidisciplinary diagnostic approach incorporating imaging, histopathology, and molecular testing facilitates early diagnosis and successful treatment with anti-tubercular therapy.