A 35-year-old lady, agriculturist by occupation and mother of two children came with painful breast lump in the right side since 3 months. There was no history of fever, cough, or weight loss. Past history revealed that she had similar complaints in the left breast 5 months back which subsided on spontaneous rupture with discharging sinus along with a course of antibiotics. Family history revealed that the patient's in-laws were known cases of pulmonary tuberculosis on treatment.
Clinical examination revealed diffuse firm lump palpable in the right upper quadrant measuring 4 cm x 3 cm. Left breast showed a healed ulcer in the left upper outer quadrant. No axillary lymph nodes were palpable. A clinical differential diagnosis of breast abscess and malignancy was made.
Complete hemogram, biochemical investigations and chest radiography were within normal limits. Eight milliliter of purulent material was obtained and on fine needle aspiration, smears showed features of granulomatous mastitis. Ziehl Neelsen stain for acid fast bacilli was positive [Figure 1]. Rapid slide culture for Mycobacterium tuberculosis showed growth after 1 week. Lowenstein Jensen (LJ) medium showed growth of typical tubercle bacilli after 4 weeks and confirmed by niacin tests [Figure 2]. A diagnosis of primary tubercular mastitis was made, a four drug regimen of anti-tubercular therapy was initiated and the patient responded well with drastic reduction of symptoms.