ట్రాపికల్ మెడిసిన్ & సర్జరీ

నైరూప్య

Pulmonary Koch’s Defaulter Presenting as Breast Lump: A Diagnostic Dilemma

Amit Mishra*, Ravi Kale, Adarsh Kumar Chauhan

Introduction: Tuberculosis is wisely said to be a great mimicker. Because of ability to have myriad presentations it is often said to be often present as one of the differentials in most of enigmatic cases with dubious or non-conspicuous diagnoses. Pulmonary Koch’s defaulter presenting as granulomatous mastitis secondary to pulmonary tubercular abscess is an uncommon presentation that posed as a diagnostic dilemma in the index case.

Case presentation: 50 year rural women presented in outdoor with complaints of slightly painful right sided breast lump for more than six months. There was no history of trauma, Diabetes Mellitus (DM), Hypertension (HTN), any previous lump, any previous surgeries, any history of malignancies or breast lumps in family. Patient had been treated for persistent cough at her native village. Patient has had history of irregular intake of Anti-Tubercular Treatment (ATT) from Government set up after being diagnosed as a case of pulmonary tuberculosis. Local examination revealed an irregular lump in upper inner and outer quadrants 6 cm × 4 cm, irregular in shape, well defined margins, firm to hard, minimally tender, not fixed to underlying muscles or overlying skin.

Results: After proper workup, patient was operated, and well marginated abscess was dissected and evacuated. Antitubercular treatment was started and continued leading to successful amelioration of the condition.

Conclusion: Unusual presentation of old pulmonary Koch’s patient who has defaulted in treatment presented with unilateral breast lump posed as a challenge in proper diagnosis. Surgery after clinical radiological correlation followed by antitubercular therapy resulted in remission of the condition.