Secondary MDR Tuberculosis of the Breast

Tuberculosis (TB) of breast is an uncommon disease even in countries where the incidence of pulmonary & extra-pulmonary tuberculosis (EPTB) is high. Reports from India have been few. In India, the incidence of tuberculous mastitis has been reported to be between 1&4.5%. Reported incidence of breast TB amongst the total number of mammary conditions varies from 0.64 to 1.6% in developed countries to 3 to 4.5% in developing countries. We report a case of secondary tuberculous mastitis in a patient with primary pulmonary tuberculosis where the fine needle aspiration cytology (FNAC) report showed no caseous necrosis. The aspirated pus yielded Mycobacterium tuberculosis (MTB) on Lowenstein-Jensen (LJ) medium which was resistant to isoniazid and rifampicin. We wish to report this case because of the rarity of tuberculous breast abscess caused by multidrug resistant Mycobacterium tuberculosis and its uncommon presentation and also to emphasise the importance of isolation of MTB from cases of EPTB where the FNAC is not suggestive of TB.