Multifocal tuberculosis with breast localization: a case of an elderly patient followed at the Matlaboul Fawzaini National Hospital in Touba, Senegal

Introduction: Tuberculosis is a common infectious disease in developing countries, mainly affecting the lungs, but it can also manifest in extrapulmonary forms. Multifocal tuberculosis, defined as involvement of at least two extrapulmonary sites, with or without pulmonary involvement, is rare and serious, occurring most often in immunocompromised individuals. Breast involvement is exceptional. Clinical case: We report the case of a 72-year-old female patient with no known medical history, admitted for evening and night fever, asthenia, anorexia, and epigastric pain that had been developing for a month, in the context of a chronic drained left breast abscess. Clinical examination revealed bilateral pulmonary consolidation syndrome, inflammatory cervical and axillary lymphadenopathy, suppurative left breast collection, marked deterioration in general condition, and severe malnutrition. The PCR test for Mycobacterium tuberculosis in sputum was positive. Chest imaging showed left apical pulmonary cavities, right basal infiltrates, and left breast infiltration associated with axillary lymphadenopathy. Pathological examination of breast and lymph node biopsies revealed granulomatous mastitis and giant cell epithelioid granulomas with caseous necrosis, with no signs of malignancy. The diagnosis of multifocal pulmonary, lymph node, and breast tuberculosis was confirmed. Standard anti-tuberculosis treatment (RHZE) under the DOTS strategy, combined with nutritional and local care, was initiated with favorable clinical progress. Conclusion: Multifocal tuberculosis is a rare and severe form of the disease that can occur in immunocompetent elderly individuals. Its location in the breast, which is exceptional, can mimic a tumor and delay diagnosis. Mycobacterium tuberculosis PCR and pathological examination are essential for diagnosis. Any symptoms suggestive of malignancy should prompt investigation for tuberculosis, particularly in endemic areas. Keywords: Multifocal tuberculosis, Mycobacterium tuberculosis, Breast localization, PCR (Polymerase Chain Reaction), Epithelioid granuloma, Caseous necrosis.