Breast lump: A rare presentation of tuberculosis
The following case has been published in the recent issue of International Journal of Applied and Basic Medical Research.

A 19-year-old girl presented with a history of pain and lump in the left breast for 20 days. Furthermore, she presented with a history of on and off fever for 2 months. The girl is a known case of congenital cataract. There was a significant history of tuberculosis in the family. Her brother had tuberculosis 2 years back and had completed treatment. She was pale, poorly built, and malnourished.

Local examination revealed swelling in the breast measuring 4 cm × 5 cm, present over the upper inner quadrant, variable in consistency. There was rise in temperature at the site, tender, fluctuation test positive, and no axillary lymphadenopathy seen.

Ultrasonography of swelling reported as mastitis with abscess formation. Fine-needle aspiration cytology (FNAC) revealed abundant acute inflammatory cells, mainly neutrophils, few lymphocytes, and absence of granulomatous lesion. Hemoglobin was 8.1 g%, and white blood cell counts were 6200/cumm with polymorphonuclear cells 50 and lymphocytes 44. Erythrocyte sedimentation rate was found to be 60mm/hr at the end of 1 h.

Chest X-ray did not reveal any lesions. With these findings, the surgeon incised and drained the pus and sent for microbiology laboratory. Gram's stain showed that there were plenty of pus cells and no organisms were found. In routine bacteriological culture, there was no growth. ZN stain revealed acid-fast bacilli.

Reinforcing our microscopic finding, the specimen was further confirmed as M. tuberculosis complex by cartridge-based nucleic acid amplification test (CBNAAT)/GeneXpert and was sensitive to rifampicin. The patient was referred to Revised National Tuberculosis Programme (RNTCP) for antitubercular therapy.

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