Primary or secondary breast tuberculosis

Specialty: Gynecology and breast.

• Tuberculous mastitis
• mycobacterial infection in the breast
• tuberculous breast abscess

Why it occurs

• Infection of the mammary gland by Mycobacterium tuberculosis, either primarily by direct inoculation through skin abrasions or milk ducts, or secondary by lymphatic or hematogenous dissemination from a previously active pulmonary or lymph node focus

Initial workup

Tuberculin skin test (Mantoux) or interferon gamma release assay (IGRA/Quantiferon-TB in blood). Breast ultrasound and mammography (show complex masses, areas of cystic necrosis, fistulous tracts and coalescent axillary lymph nodes). The definitive diagnosis is made by core needle biopsy (CNB) of the mass or fistula wall for histopathological study (typical caseating granulomas with Langhans giant cells are observed) and PCR for Mycobacterium tuberculosis in the biopsied tissue, complemented by Löwenstein-Jensen culture of the secretion.

Standard management

• Standard four-drug anti-tuberculosis regimen for a total of 6 months: Initial phase of 2 months with Isoniazid (5 mg/kg/day, max 300 mg), Rifampicin (10 mg/kg/day, max 600 mg), Pyrazinamide (20-30 mg/kg/day, max 2 g) and Ethambutol (15-25 mg/kg/day, max 1.6 g) orally daily; followed by a 4-month continuation phase with Isoniazid and Rifampicin (note: combine Pyridoxine/Vitamin B6 25-50 mg/day to prevent peripheral neuropathy induced by isoniazid).