A 25-year-old female presented with a painless lump in her right breast for 1 month duration. She gave history of low grade fever off and on for the last 2 weeks. There were no other complaints like weight loss, loss of appetite, and any cough. She was unmarried and there was no positive family history of breast tuberculosis. On local examination, a non-tender lump of size 3 x 4 cm was felt in lower quadrant of the breast [marked with a line as a - Figure 1]. It was freely mobile and no axillary nodes were present. Another 1 x 1.5 cm swelling was present in infra-mammary area just below and medial to the above mentioned lump [marked by line b; Figure 1]. Her systemic examination was non-contributory.
On routine blood investigations, total leucocyte count was 12,000 mm3 and erythrocyte sedimentation rate (ESR) was 60 mm at the end of 1 h, and HIV test was negative. Her fasting blood sugar and blood urea levels were normal. Chest X-ray was normal. Fine needle aspiration cytology (FNAC) of the breast and infra-mammary lump showed granulomas, epitheloid cells, and mixed inflammatory cells [Figure 2]. Background consisted of necrotic material and ZN stain for acid fast bacilli (AFB) was positive in the FNAC of both lumps. Mountex test was not done as on FNAC diagnosis already was made. Final diagnosis made as breast TB.
She was put on a 6-month course of anti-tubercular therapy with a 2 month intensive phase of rifampicin, isoniazid, ethambutol, and pyrazinamide followed by a consolidation phase of rifampicin and isoniazid for another 4 months. The lump size was decreased within 3 weeks of initiation of ATT and at 3 month follow-up the patient remains asymptomatic and both lumps disappeared. She was advised to continue treatment.