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Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 80  

Nipple discharge: An uncommon presentation of a common disease, Tuberculosis

1 Department of Microbiology, Government Medical College, Haldwani, Uttarakhand, India
2 Department of Radiology, Government Medical College, Haldwani, Uttarakhand, India
3 Department of Microbiology, CSMMU, Lucknow, Uttar Pradesh, India

Date of Web Publication28-Jan-2013

Correspondence Address:
Monil Singhai
Department of Microbiology, Government Medical College, Haldwani, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-7406.106568

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How to cite this article:
Singhai M, Rawat V, Joshi V, Jain P. Nipple discharge: An uncommon presentation of a common disease, Tuberculosis. J Pharm Bioall Sci 2013;5:80

How to cite this URL:
Singhai M, Rawat V, Joshi V, Jain P. Nipple discharge: An uncommon presentation of a common disease, Tuberculosis. J Pharm Bioall Sci [serial online] 2013 [cited 2020 Sep 24];5:80. Available from:


The incidence of tuberculosis is quite high in our country and, consequently, tuberculosis of breast may be frequent enough but possibly overlooked or misdiagnosed as carcinoma or pyogenic abscess. [1] The most common mode of spread to the breast is lymphatic and hematogenous, although spread from contagious structures, direct inoculation and ductal infection are other rare modes of spread of this disease. [2] Tubercular mastitis can present as nodulocaseous, disseminated and breast abscess. [2] Moreover, superadded bacterial infection further causes misdiagnosis of this disease as pyogenic abscess. Acid fast bacilli (AFB) microscopy and culture is considered as the gold standard for the diagnosis of tuberculosis, although paucibacillary specimens and time required for culture are important limitations. Fine needle aspiration has also been advocated as an important diagnostic tool in breast tuberculosis, but secondary bacterial infection can often be misleading. [1] The advent of newer diagnostic techniques such as automated mycobacterial growth systems (BACTEC) and nucleic acid amplification have been explored as time saving and sensitive techniques. The management of this disease depends on sound diagnosis and anti-tubercular therapy, with surgery having a minimal role. [1],[3]

A 40-year-old woman reported in the Surgery Outpatient Department with nipple discharge. The patient noted painless lump in the left breast 11 months back. The lump was tender, irregular and approximately 3 cm × 1 cm in size, and was confirmed by sonomammagram to be in the subareolar area. Excision biopsy of the lump was done 5 months back and sent for histopathological examination, but no confirmatory diagnosis could be made. The patient was asymptomatic since then, except a very little purulent nipple discharge since the last 45 days. There was no history of fever, cough, loss of appetite and tuberculosis in the past or in any family member, and no other focus of tuberculosis in the body was found. Nipple discharge was sent for AFB microscopy and culture. The nipple discharge showed presence of acid fast bacilli on Ziehl Neelson stain in the discharge and culture on Lowenstein-Jensen media showed Mycobacterium tuberculosis. Methicillin-resistant Staphylococcus aureus was also obtained on aerobic culture on Blood agar, confirming the diagnosis of primary tubercular mastitis with secondary bacterial infection. The route of infection may be direct spread when excision biopsy of the breast was taken.

An uncommon route of infection has been assumed to be "traumatic inoculation" if there had been a history of local trauma or surgery (through contaminated instruments) without pulmonary or other extrapulmonary tuberculosis features in patients. [4] An excision biopsy is often advocated in breast lesions to rule out sarcoidosis, ductularectasia, fungal infections and malignancy. [3] Sonomammogram is also one of the affordable and easily available investigation that helps in characterizing breast lesions without exposure to radiation. [2]

However, clinical and radiological mimickry of tubercular mastitis with breast abscess and carcinoma often leads to a diagnostic dilemma. Therefore, AFB microscopy and culture turns out to be a simple and effective investigation for confirming the diagnosis of tubercular mastitis if meticulous attention is paid, especially in a resource-constrained set up.

   References Top

1.Hatwal D, Suri V, Mishra JP, Joshi C. Tubercular mastitis is common in garhwal region of uttarakhand: Clinico pathological features of 14 cases. J ClinDiagn Res 2011;5:1569-73.  Back to cited text no. 1
2.Tewari M, Shukla HS. Breast tuberculosis: Diagnosis, clinical featuresand management. Indian J Med Res 2005;122:103-10.  Back to cited text no. 2
3.Baharoon S. Tuberculosis of the breast. Ann Thorac Med 2008;3:110-4.  Back to cited text no. 3
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4.Wang JY, Lee LN, Hsueh PR, Shih JY, Chang YL, Yang PC, et al. Tuberculous myositis: A rare but existing clinical entity. Rheumatology (Oxford) 2003;42:836-40.  Back to cited text no. 4


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