Breast Lump: A Rare Presentation of Tuberculosis in an Elderly Man

  • Sofia Gomes Brazao Internal Medicine, Centro Hospitalar e Universitário de Coimbra e Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  • Regina Costa Internal Medicine, Centro Hospitalar e Universitário de Coimbra e Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  • Miguel Nico Albano Internal Medicine, Centro Hospitalar e Universitário de Coimbra e Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  • Nelson Jesus Internal Medicine, Centro Hospitalar e Universitário de Coimbra e Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  • Armando Carvalho Internal Medicine, Centro Hospitalar e Universitário de Coimbra e Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Keywords

Tuberculosis, breast lump, infectious disease, geriatric medicine

Abstract

Introduction: Chest wall masses are caused by various entities and have diverse aetiologies. A careful history and physical examination are crucial to establish the correct diagnosis.
Case report: A 77-year-old man presented with depressive mood, anorexia (weight loss of 20 kg) and a 1-month history of a non-painful breast lump with well-defined contours, which was about 6 cm in diameter. There was no history of trauma. Computed tomography of the thorax revealed a collection of liquid in the left anterior thoracic wall, associated with discontinuity of the 4th left costal cartilage, and upper left lobe cavitation, suggesting pulmonary tuberculosis. The patient was started on quadruple therapy with anti-tuberculosis drugs and discharged after a negative smear.
Conclusion: In this case, the indolent onset of unspecific symptoms made it difficult to reach a diagnosis of pulmonary tuberculosis, which was confirmed by positive culture and imaging. A breast lump in an elderly patient with unspecific clinical manifestations is an unusual presentation of pulmonary tuberculosis. It is important to be aware of rib invasion and exclude tuberculosis in a patient with a chest wall mass. As tuberculosis is treatable, early diagnosis is vital as diagnostic delay can lead to contagion.

References

  • Reed J. Chest wall lesions. In: Reed J, editor. Chest radiology patterns and differential diagnoses. 7th ed. Philadelphia: Elsevier; 2018. p. 8–19.

  • Chau A, Jafarian N, Rosa M. Male breast: clinical and imaging evaluations of benign and malignant entities with histologic correlation. Am J Med 2016;129(8):776–791.

  • Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH. Thoracic sequelae and complications of tuberculosis. Radiographics 2001;21(4):839–858.

  • Hussain S. Chest wall tuberculous ulcer: a rare complication of pulmonary tuberculosis. Indian J Tuberc 2016;63(4):265–267.

  • Hossain M, Azzad A, Islam S, Aziz M. Multiple chest wall tuberculous abscesses. J Pak Med Assoc 2010;60(7):589–591.

  • Grover SB, Jain M, Dumeer S, Sirari N. Chest wall tuberculosis - a clinical and imaging experience. Indian J Radiol Imaging 2011;21(1):28–33.

  • Teo TH, Ho GH, Chaturverdi A. Tuberculosis of the chest wall: unusual presentation as a breast lump. Singapore Med J 2009;50(3):97–99.

  • Tanaka S, Aoki A, Nakanishi T, Otake Y, Matsumoto M, Sakurai T, et al. Retrospective case series analysing the clinical data and treatment options of patients with a tubercular abscess of the chest wall. Interact Cardiovasc Thorac Surg 2012;14:249–252.

  • Matos V, Santos A. On the trail of pulmonary tuberculosis based on rib lesions: results from the human identified skeletal collection from the Museu Bocage. Am J Phys Anthropol 2006;130(2):190–200.

  • Santos A, Roberts C. Anatomy of a serial killer: differential diagnosis of tuberculosis based on rib lesions of adult individuals from the Coimbra identified skeletal collection, Portugal. Am J Phys Anthropol 2006;130(1):38–49.

  • Sequeira F, Wong J, Carrasco R, Vergara C. Tuberculous abscess of the thoracic wall secondary to nodular tuberculosis: atypical presentation in an older adult. Gac Med Mex 2017;153:370–373.

  • Rajagopalan S, Yoshikawa TT. Tuberculosis in the elderly. Z Gerontol Geriatr 2000;33(5):374–380.

  • Rajagopalan S. Tuberculosis in older adults. Clin Geriatr Med 2016;32(3):479–491.
  • Keum D-Y, Kim J-B, Park C-K. Surgical treatment of a tuberculous abscess of the chest wall. Korean J Thorac Cardiovasc Surg 2012;45(3):177–182.

  • Khalil A, Breton C, Tassart M, Korzec J. Utility of CT scan for the diagnosis of chest wall tuberculosis. Eur Radiol 1999;9(8):1638–1642.

  • Grover S, Jain M, Dumeer S, Sirari N. Chest wall tuberculosis - a clinical and imaging experience. Ind J Radiol Imaging 2011;21(1):28–33.

  • Kuzucu A, Soysal O, Günen H. The role of surgery in chest wall tuberculosis. Interact Cardiovasc Thorac Surg 2004;3(1):99–103.

  • Kim YT, Han KN, Kang CH, Sung SW, Kim JH. Complete resection is mandatory for tubercular cold abscess of the chest wall. Ann Thorac Surg 2008;85:273–277.

  • Ursavaş A, Ege E, Bilgen ÖF, Taşdelen İ, Coskun F, Sönmez S, et al. Breast and osteoarticular tuberculosis in a male patient. Diagn Microbiol Infect Dis 2007;58(4):477–479.
  • Published: 2019-05-20

    Issue: Vol 6 No 5 (view)

    Section: Articles

    How to cite:
    Brazao, S., Costa, R., Albano, M., Jesus, N., & Carvalho, A. (2019). Breast Lump: A Rare Presentation of Tuberculosis in an Elderly Man. European Journal of Case Reports in Internal Medicine, 6(5). https://doi.org/https://doi.org/10.12890/2019_001113