Breast Brucellosis in Taif, Saudi Arabia: cluster of six cases with emphasis on FNA evaluation

Abstract

Background: Brucellosis is an endemic zoonosis seen in a variety of geographical locations such as the Middle East and Latin American and Mediterranean countries. Brucellosis is hyper-endemic in Saudi Arabia with an incidence of 5.4 per 1000 per year. Breast involvement very rarely occurs as a focal complication of brucellosis. Methodology: We report six cases of breast brucellosis retrieved from the files of the patients. Fine needle aspiration (FNA) was performed on all patients. In all cases direct smears were made at the patient's side for assessment of sample quality. Cytospin and cell block preparation was done and Gram, periodic acid-Schiff and Ziel-Nelson stains were done on all samples. Microbiological analysis included routine fungal and bacterial culture for tuberculosis. Results: Age range was 20 to 48 years with a median of 22 years. Two patients gave history of raw milk ingestion, one was lactating, and one patient was pregnant. Cytomorphologic features of brucellosis in the breast include an abscess-like background with granulomatous inflammation. Cytology of the patients presented with breast abscess showed predominant neutrophilic infiltrate compatible with acute pyogenic inflammation. Culture was positive for B. melitensis in all cases. Conclusion: Brucellosis should be kept in mind in the differential diagnosis of breast abscess in endemic areas where ingestion of unpasteurized milk and milk products is common. Needle aspiration establishes a preliminary diagnosis and has the advantage of material submission for microbiologic cultures and provides focal treatment along with long-term combined antibacterial treatment for the control of systemic infection.

Idiopathic bilateral male breast abscess

“…Male breast abscess is documented in individuals with HIV infection,1 9 duct ectasia2 and following enteric fever (as extraintestinal complication of Salmonella infection) 5. The other rare causes include tuberculosis of breast10 11 and chest wall,12 brucellosis,13 squamous cell carcinoma and,14 belladonna application as a topical agent 15. The last one is a common ritual practiced by Sadhus (ascetics/priests) of India, of applying bhasm (ash mixed with various other substances including Atropa ) to various parts of their body, which could be a probable cause in this case.…”

Transmission of Infectious Diseases Through Breast Milk and Breastfeeding

“…259,260 There have been eight cases of brucellosis in infants that were possibly associated with breastfeeding, but Brucella was not isolated from the breast milk in any of those cases. 295 Only one of six women described in this report was lactating at the time of diagnosis, and no information about the infant was given. 415 Additionally, Brucella melitensis has been cultured from women with breast lumps and abscesses.…”

Chest wall involvement as a manifestation of Brucellosis

“…[610–14] Chest wall involvement (for example, cold abscess, rib involvement) in tuberculosis is a typical manifestation but in brucellosis is very unusual. [6] We did not find chest wall involvement (abscess, mass, etc) as the manifesting feature of brucellosis in the literature.…”