CASE PRESENTATION
A 34-year-old woman presented to our hospital, Clinical Hospital of the
President Association and the Government of the Kyrgyz Republic,
Bishkek, with complaints of a unilateral right painless breast lump of 2
months’ duration. The initially painless lump became painful with
induration of the skin, ulcer formation, and purulent discharge (pus)
from the sinus on the right breast for 20 days before hospitalization.
She denied a history of weight loss, night sweats, loss of appetite, and
respiratory symptoms. There was no family history of breast cancer,
tuberculosis, or other pulmonary diseases. The systemic examination was
normal.
Local examination of the right breast revealed a 1.0-cm sinus in the
upper outer quadrant with a 2×2-cm palpable lump, and purulent discharge
was noted. There were no clinical manifestations or abnormalities in the
left breast or nipple-areolar area and no signs of nipple discharge.
Except for the elevated erythrocyte sedimentation rate (102 mm/h), her
laboratory panel was within normal limits. The patient underwent
computed tomography of the neck, abdomen, and breast, which showed a
2×2-cm lump in the right breast. Unilateral axillary lymphadenopathy was
noted on the right side with multiple nodes ranging from 10 to 20 mm in
size. Further evaluation of the right breast with ultrasound examination
revealed a hypoechoic lesion with heterogeneous formation (87×17 mm)
with elongated and irregular borders. Doppler ultrasonography (US)
revealed elevated circumferential vessels in the central avascular
lesions as a sign of existing infection, and a diagnosis of breast
abscess was made.9 However, there was no symptom
alleviation even after a week of co-amoxiclav (1000 mg) every 12 h.
For a definitive diagnosis, the patient underwent FNAC of the right
breast lump. Touch imprint smears prepared from the pus revealed
acid-fast bacilli (AFB) on Ziehl–Neelsen (ZN) staining. Histological
study of tissue pieces revealed the presence of Langhans giant cells,
epithelioid cell granulomas, caseous necrosis, lymphocytes, necrotic
foci, and fibroblast clusters. Mycobacterium tuberculosis complex was
confirmed by a cartridge-based nucleic acid amplification test sensitive
to rifampicin in the FNAC sample.
Excision of the fibrous tract and resection of the rib with pus and
necrotized tissue were performed. The patient was started on standard
antitubercular therapy (ATT) with 2-month regimen (isoniazid,
rifampicin, pyrazinamide, and ethambutol), followed by 4-month regimen
(isoniazid and rifampicin). She consistently visited the hospital for
follow-up for 1 year, and no disease recurrence was noted.