Isolated Primary Breast Tuberculosis - Report of Three Cases and Review of the Literature

Tuberculosis (TB) is a very old disease, and tuberculosis bacilli have co-existed with humans as far back as 5000 BC, according to studies of the spine TB lesions (Pott’s disease) from Egyptian mummies.1 TB continues to be a frequent cause of mortality and morbidity, with an incidence rate of 150 cases per 100,000 people in 2005. Currently, one person becomes newly infected every second worldwide.2 TB mostly affects the lungs as it is an airborne infectious disease, but any organ can be affected as a result of hematogenous spread. It has been suggested that some organs and tissues like the mammary gland tissue and spleen offer resistance to the survival and multiplication of tuberculosis bacillus.3 Hence, tuberculosis of the breast is an uncommon disease, with an incidence between 0.1%– 3% of all breast diseases treated surgically.4 Its incidence is likely to be higher in undeveloped countries as a result of the high TB incidence, but with an increasing spread of HIV in developed countries, this pattern of incidence may change. TB is a very rare disease, so a high level of suspicion is required to make the diagnosis. Breast TB can mimic breast carcinoma or breast abscess, clinically and radiologically. Concomitant axillary lymph nodes were found in one-third of the patients with breast TB.5 This paper presents three cases to argue that breast TB should be included in the differential diagnosis of breast lesions, like breast carcinoma, persistent breast abscess and infectious patterns with fistulizations, especially for patients from high risk populations and endemic regions.