Breast tuberculosis or granulomatous mastitis: A diagnostic dilemma

Breast tuberculosis is an uncommon disease with nonspecific clinical, radiological, and histological findings. Investigations such as microscopy and culture are frequently negative, and diagnosis is frequently one of exclusion. We report a case of tuberculous breast abscess in a 46-year-old female case of Carcinoma Maxilla on palliative radiochemotherapy. Equivocal histology, negative Ziehl-Neelsen stain, and culture for acid-fast bacilli resulted in the abscess initially being diagnosed as granulomatous mastitis and treated accordingly. Subsequent development of a discharging sinus and history of immunosuppression raised suspicion of culture-negative tuberculosis. Treatment with standard antituberculous drugs was associated with complete resolution of the breast abscess. This case highlights the difficulty in differentiating culture negative tuberculosis from granulomatous mastitis. Also, the unusual age of presentation following radio and chemotherapy is noteworthy.