Diagnostic challenge: a case report of primary breast tuberculosis mimicking recurrent pyogenic breast abscess

Introduction: Breast tuberculosis (BTB) is a rare form of extrapulmonary tuberculosis with its primary form considered even rarer.

Case presentation: A 28-year-old female initially diagnosed with a breast abscess presented with chronic right breast pain and nipple discharge. Despite initial treatment, symptoms recurred, and further investigations revealed a space-occupying lesion. Fine needle aspiration confirmed recurrent breast abscess, but subsequent DNA detection of tubercular bacilli in the pus sample led to a diagnosis of primary BTB, necessitating antitubercular therapy.

Clinical discussion: BTB, being rare and often misdiagnosed as an abscess, poses diagnostic challenges. However, persistent symptoms despite treatment should prompt consideration of BTB in TB endemic regions.

Conclusion: Primary BTB might not have any systemic symptoms to drag the clinician towards a possible diagnosis so culturing the aspirate for acid-fast bacilli or looking for MTB DNA in the available clinical sample should always be kept in mind for better outcomes.