Tuberculosis of the breast: analysis of 20 cases and a literature review

Abstract

Tuberculosis (TB) of the breast is a very rare pathology. The clinical presentations of this disease are manifold, often mimicking carcinoma of the breast. We conducted a retrospective analysis of 20 women with TB of the breast receiving care at the mastology clinic at Getúlio Vargas Hospital, PI, Brazil, between 1994 and 2007. The clinical presentation of the disease, the diagnosis and the response to specific treatment were analyzed. Most of the patients were of reproductive age, with the disease affecting the right breast in eleven patients (55%) and the left breast in nine patients (45%). Palpable nodules were present in five patients (25%) and fistulae in 15 (75%). The mean time between onset of symptoms and diagnosis was 7.7 months (range 3-12 months). Skin testing with purified protein derivative of tuberculin was strongly reactive in all patients, six (30%) of whom were breastfeeding. Diagnosis was confirmed by histopathology and all patients were satisfactorily treated with a combination of rifampicin, isoniazid and pyrazinamide. In the present study, TB of the breast presented predominantly as breast abscesses and fistulae and responded satisfactorily to treatment with anti-TB drugs.

Breast Tuberculosis

“…In a study by Harris et al [13], one third of the patients were given a 9-month therapy. But in a study by Silva et al [51], 6-month therapy was sufficient for all patients to recover. The standard infection with multidrug-resistant tuberculosis (MDR) has been reported.…”

Tuberculosis of breast: a rare case report

“…8 Tuberculous involvement of breast occurs either by direct inoculation of the bacilli through abrasions in the nipple, which is rare or more commonly via lymphatic, hematogenous, or contiguous seeding. 9,10 Breast tuberculosis commonly affects young multiparous, lactating women.…”

“…However, histochemistry is not practical and culture of M. tuberculosis has limitations due to the delay in obtaining the final result and the possibility of falsenegative results in paucibacillary samples. 8 Treatment of breast TB with standard antituberculosis therapy for 6 months usually results in good clinical response. The regimen consists of a 2 months intensive phase (isoniazid, rifampicin, pyrazinamide, and ethambutol) followed by a 4 months continuation phase (isoniazid and rifampicin).…”

Características clínicas y anatomo-patológicas de las pacientes que ingresaron al Programa de Control de Tuberculosis con diagnóstico de tuberculosis de mama

“…Entre ellos, la afectación de la mama es extremadamente rara, con una prevalencia de 0,1% a 3-4% según la región geográfica (3)(4)(5).…”

“…En un estudio previo realizado en el HNCH, 12 (26,67%) casos con mastitis granulomatosa en tratamiento antituberculoso presentaron persistencia o recurrencia del cuadro a pesar del tratamiento (6). Esta cifra discrepa con la tasa de éxito de casi 95% reportada a nivel mundial para TB de mama con tratamiento médico (4,(7)(8)(9)(10).…”