A 22-year-old woman with no history of pregnancy or comorbidities was admitted to the Infectious Diseases Clinic at Atatürk University Medical Faculty Hospital with a 2-month history of swelling, pain, and purulence in the left breast. Her readings were as follows: leukocyte count, 7300; neutrophil value, 63%; platelet count, 232,000; C-reactive protein, 3; sedimentation rate, 5; aspartate aminotransferase, 26; alanine aminotransferase 24, PPD, 25 mm; and Quantiferon was positive. The patient was diagnosed with pulmonary tuberculosis. Ultrasonography revealed a dense lesion in the lower left breast. Lymphadenopathy (18×7 mm) was observed in the left axillary region11. Freeman CM, Xia BT, Wilson GC, Lewis JD, Khan S, Lee SJ, et al. Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge. Am J Surg. 2017;214(4):701-6. Available from: https://doi.org/10.1016/j.amjsurg.2017.07.002
https://doi.org/10.1016/j.amjsurg.2017.0...
. Despite 2 weeks of antibiotic therapy, the magnetic resonance imaging (MRI) of the breast revealed a fistulized, thick-walled abscess formation on the skin, accompanied by skin thickening in the lower inner quadrant of the left breast (Figure 1). Biopsy results indicated granulomatous mastitis. Tuberculosis-related mastitis was suspected. Anti-tuberculosis quadruple therapy (isoniazid, rifampicin, ethambutol, and pyrazinamide) was administered for 2 months, while isoniazid and rifampicin were administered for 7 months22. Farouk O, Abdelkhalek M, Abdallah A, Shata A, Senbel A, Attia E, et al. Rifampicin for Idiopathic Granulomatous Lobular Mastitis: A Promising Alternative for Treatment. World J Surg. 2017;41:1313-21. Available from: https://doi.org/10.1007/s00268-016-3857-7
https://doi.org/10.1007/s00268-016-3857-...
,33. Thimmappa D, Mallikarjuna MN, Vijayakumar A. Breast Tuberculosis. Indian J Surg. 2015;77(Suppl 3):1378-84. Available from: https://doi.org/10.1007/s12262-015-1272-1
https://doi.org/10.1007/s12262-015-1272-...
. Post-treatment MRI showed no abscess or fistula tract formation (Figure 2). The 6-month follow-up revealed no new findings, demonstrating a complete response to tuberculosis mastitis treatment. It is important for tuberculosis to be considered in cases of mastitis, particularly when differentiating from widely seen idiopathic granulomatous mastitis.
Axial T1 weighted MRI image: Pre-treatment image shows fistulized thick-walled abscess formation with thickening of the skin in the lower inner quadrant of the left breast (arrows).
ACKNOWLEDGMENTS
We offer our deepest thanks to the Atatürk University Faculty of Medicine that provided technical support for the development and implementation of this study.
REFERENCES
-
1Freeman CM, Xia BT, Wilson GC, Lewis JD, Khan S, Lee SJ, et al. Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge. Am J Surg. 2017;214(4):701-6. Available from: https://doi.org/10.1016/j.amjsurg.2017.07.002
» https://doi.org/10.1016/j.amjsurg.2017.07.002 -
2Farouk O, Abdelkhalek M, Abdallah A, Shata A, Senbel A, Attia E, et al. Rifampicin for Idiopathic Granulomatous Lobular Mastitis: A Promising Alternative for Treatment. World J Surg. 2017;41:1313-21. Available from: https://doi.org/10.1007/s00268-016-3857-7
» https://doi.org/10.1007/s00268-016-3857-7 -
3Thimmappa D, Mallikarjuna MN, Vijayakumar A. Breast Tuberculosis. Indian J Surg. 2015;77(Suppl 3):1378-84. Available from: https://doi.org/10.1007/s12262-015-1272-1
» https://doi.org/10.1007/s12262-015-1272-1
-
Financial Support: No financial support was used in this study.
Publication Dates
-
Publication in this collection
12 Nov 2021 -
Date of issue
2021
History
-
Received
06 Aug 2021 -
Accepted
08 Sept 2021