A 43-year-old woman was admitted to our hospital with complaints of swelling, breast lump and erythema of the skin in her right breast, which appeared 45 days earlier. On physical examination, a 6- to 7-cm, firm and mobile mass was observed, which caused erythema and edema of the skin in the inner lower quadrant of the left breast. There was no fistulization. Ultrasonography examination revealed a hypoechoic mass with significant ductal dilatation without collection and lymphadenopathy, which suggested mastitis.
All three patients denied smoking, having risk factors for HIV or a recent exposure to tuberculosis. They had no past history of tuberculosis, and they had no family history of breast cancer. Tuberculin skin test results (Mantoux) were 16, 13 and 14 mm for cases 1, 2 and 3, respectively. Their routine hematologic and biochemical parameters were in the normal range, including negative testing for HIV. Their erythrocyte sedimentation rates were also normal. Their sputum smears and discharge materials from the breast were found to be negative for acid-fast bacilli (AFB), both in culture and by PCR. All of their chest X-rays were normal. Both trucut and fine needle biopsy were applied to their breast lesions. Their pathological examinations showed chronic granulomatous inflammation with areas of central necrosis, epithelioid granulomas with Langhans giant cells and lymphohistocytic aggregates suggestive of tuberculosis (Fig-3). The patients were all diagnosed as breast tuberculosis according to pathological examinations. The intensive therapy with anti-tuberculosis drugs (isoniazid 300 mg, rifampicin 600 mg, pyrazinamide 1500 mg and ethambutol 1000 mg per day) was initiated for 2 months and continued with the addition of rifampicin and isoniazid therapy for an additional four months. With treatment, their breast lesions and tenderness steadily improved. Cures were obtained for all patients at the end of the sixth month period.