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Case report
Abstract
A 28-year old male presented to our clinic complaining of a recent
onset of a painful right breast lump with redness and nipple discharge.
Fine-needle aspiration biopsy revealed caseating granulomas, with a
culture positive for Mycobacterium tuberculosis. He was found to have
a positive PPD, but no other site of pulmonary or extra-pulmonary
tuberculosis was identified. Treatment with anti-tuberculous drugs lead
to complete clinical resolution of the breast lesion. The breast is a rare
site of extra-pulmonary tuberculosis (TB), comprising only 0.1% of
all cases. TB is re-emerging in the Western world with the increasing
prevalence of immunosuppressive disorders. Increasing immigration
rates and widespread travel are further contributing to TB globalization.
With the re-emergence of TB, atypical forms are appearing, with an
increase in the proportion of extra-pulmonary disease and a widening
of the age range at presentation. Tuberculous mastitis(TM) is found
mostly in young, multiparous women. Male TM is extremely rare,
and accounts for only 4% of all cases. This strikingly lower incidence
in males points towards a significant role of parity, pregnancy and
lactation as likely predisposing factors. Although a rare disease, TM
is an important differential diagnosis for breast cancer. A high index of
suspicion is the cornerstone for diagnosis. Awareness of this condition
is important not only for dermatologists, but for surgeons, radiologists
and pathologists, as well. Clinicians are encouraged to provide a careful
assessment of the breasts, an important organ also in men. Clin Ter
2013; 164(4):e??-??. doi: 10.7417/CT.2013.????
Key words: antituberculous drugs, breast cancer, caseating granulomas, mastitis, tuberculosis
the male breast (2). Most other diseases found in the male
breast arise from the skin and subcutaneous tissues (e.g., fat
necrosis, lipoma, epidermal inclusion cysts). Some lesions
that are common in the female breast (e.g., fibroadenomas)
do not occur in the male breast. Breast pain (mastalgia) in
males is a rare phenomenon.
Mastitis is the inflammation of the mammary gland;
there are two types: puerperal and non puerperal mastitis.
Puerperal mastitis is the inflammation of breast in connection with pregnancy, breastfeeding or weaning. It is usually
caused by blocked milk ducts or milk excess. In fact the
most prominent symptoms is tension and engorgement of
the breast. If untreated, the milk left in the breast tissue can
become infected, leading to infectious mastitis. It is relatively common; however only about 0.4-0.5% of breastfeeding
mothers develop an abscess (3).
Nonpuerperal mastitis is the inflammation of breast tissue
occurring unrelated to pregnancy and breastfeeding. This
is caused by a wide range of organisms, including gramnegative and gram-positive bacteria and mycoplasmas4.
Staphylococcus aureus is the most common etiological
organism responsible, but staphylococcus epidermidis and
streptococci are occasionally identified as well. It is important to receive treatment immediately to prevent complications, such as an abscess in the breast (5).
Nonpuerperal mastitis is also caused by Mycobacterium
tubercolosis. Tuberculous mastitis is an uncommon form
of extrapulmonary tuberculosis. It is predominant in young
women; the common age concerned between 20 to 40 years,
the period of reproductive age (6). Breast tuberculosis is
extremely rare in males.
Introduction
Case report
A 28-year-old man was admitted to our clinic complaining for a painful progressive swelling of the right breast.
He denied fever, chills, night sweats, weight loss, and
any other systemic symptoms. He had no past medical or
Correspondence: Dott. Carmen Cantisani, MD. Department of Oncoematology-Dermatology and Plastic Surgery. Azienda Policlinico Umberto
I, University Sapienza, Viale del Policlinico 155, 00161 Rome, Italy. Alternative address: Viale Regina Margherita 244, 00198 Rome, Italy.
Tel.:+39.347.9385719; Fax: +39.06.490243. E-mail: carmencantisanister@gmail.com or carmen.cantisani@uniroma1.it
Copyright Societ Editrice Universo (SEU)
ISSN 1972-600
e184
C. Cantisani
e185
Acknowledgments