Introduction Breast tuberculosis (TB) is rare and diagnosis may be delayed. It was first described in 1829. Incidence is highest in TB endemic areas. Here we describe a series of cases diagnosed in East London (UK).
Methods We conducted a retrospective study of all patients treated at our institution for breast TB between 2005 – 2015. Data including demographics, symptoms, microbiological, histological diagnoses and treatment outcomes were recorded.
Results 35 cases of breast TB were identified (1 male). Mean age at diagnosis was 33 years (range 16 – 63). 24 patients were from the Indian subcontinent, 3 Asian other, 7 Black-African and 1 Middle Eastern; no patients were Caucasian. Three patients were lactating, two were pregnant. Four patients had a previous history of TB and one was HIV positive. All patients presented with a breast lump, 58% in the upper outer quadrant. 25 patients initially presented to their general practitioner (GP), of which 24 were referred to breast clinic and 1 directly to TB clinic. Eight cases presented to hospital. In two cases there was insufficient data. The breast lump was associated with skin changes in six cases, inverted nipple in three, discharge in one, and 49% had ipsilateral axillary lymphadenopathy. Erythrocyte sedimentation rate and C-reactive protein was raised in 84% and 53% cases respectively. Thirty percent of patients had abnormal mammography, 68% abnormal ultrasound breast findings. 25 out of 35 cases had biopsies/fine needle aspirations (FNA), all of these were sent for culture; 17 were culture positive with 3 drug resistant cases. Nine cases had necrotising granulomatous changes on histology, of which 1 was positive for Ziehl-Neelson (ZN) stain, 9 cases had non-necrotising granulomas, of which 2 were ZN positive, and 7 cases had inflammatory changes only (none were ZN positive). All patients received at least three anti-tuberculous drugs. Median treatment duration was six months, leading to complete resolution of breast TB.
Conclusion This case series highlights the difficultly in diagnosing breast TB. Raising awareness of the classical presentation of breast TB amongst GPs and breast services may improve diagnosis and treatment of this rare disease.