Extrapulmonary Tuberculosis Presenting as a Suspected Case of Metastatic Breast Cancer

Abstract

Extrapulmonary tuberculosis (TB) represents a diagnostic challenge. Bone TB is an uncommon and important presentation of extrapulmonary TB, which can lead to bone destruction, deformity and even paraplegia. Breast TB is rare and often confused with neoplasia, since the clinical and imaging presentations are not specific. Any of these extrapulmonary TB presentations, in the absence of cultural isolation of mycobacteria, oblige the exclusion of other diseases (secondary or infectious diseases). The authors report a case of multifocal extrapulmonary TB, as an example of the problem with the differential diagnosis of the disease. LEARNING POINTS Extrapulmonary TB remains a diagnostic challenge. Consider breast TB as a differential diagnosis of mammary nodules. A high level of suspicion is necessary to make an early diagnosis and start appropriate treatment before irreversible damage takes place.

A case report of coexisting breast cancer with peritoneal, cutaneous tuberculosis, and potential Pott’s disease: therapeutic and diagnostic challenges

“…Bone tuberculosis is an ancient disease dating back to the Iron age and was also detected in Egyptian mummies 4 . Multiple risk groups associate with a higher incidence of this disease, such as AIDS patients, transplant recipients, and immigrants from populations where HIV or TB infections are endemic 9 , 10 . This risk group classification aids in early disease suspicion and better management plans.…”

“…The role of different diagnostic investigations in confirming a diagnosis of tuberculous spondylitis is limited. TB is usually described as a paucibacillary disease, explaining the low sensitivity of direct detecting of mycobacterium by culture or Ziehl-Neelsen staining in only 25% of cases 9 , 11 . The published literature reported negativity of TB tests despite presence of Pott’s disease (negative acid-fast bacilli smear 9 , 12 , 13 , negative culture and polymerase chain reaction 13 ) and the diagnosis of TB was made despite those findings with marked improvement after therapy 9 , 13 .…”