Kao Pao-Tsuan, Tu May-Yu, Tang Sai-Hung, Ma Hon-Kwong
Department of Internal Medicine, Cardinal Tien Hospital, Yongho Branch, Jhongsing Street, Yongho City, Taipei County, Taiwan 234.
J Med Case Rep. 2010 Apr 29;4:124. doi: 10.1186/1752-1947-4-124.
There has been an increasing number of tuberculosis cases worldwide, but tuberculosis of the breast remains rare. In rare cases this is seen with a cutaneous manifestation of erythema nodosum.
We report the case of a 33-year-old Chinese woman with tuberculosis of the left breast accompanied by erythema nodosum on the anterior aspect of both lower legs. Due to her poor clinical response to conventional therapy, and the histopathological findings of fine needle aspiration cytology, there were strong indications of tuberculosis. Her clinical diagnosis was confirmed by molecular detection of Mycobacterium tuberculosis complex by polymerase chain reaction. The diagnosis was further confirmed by a second polymerase chain reaction test of erythema nodosum which tested positive for Mycobacterium tuberculosis complex. She received anti-tuberculous therapy for 18 months, and finally underwent residual lumpectomy. During her follow-up examination after 12 months, no evidence of either residual or recurrent disease was present.
Histopathological features and a high index of clinical suspicion are necessary to confirm a diagnosis of tuberculosis of the breast. Anti-tuberculous therapy with or without simple surgical intervention is the core treatment.
全球结核病病例数量不断增加,但乳腺结核仍然罕见。在极少数情况下,可伴有结节性红斑的皮肤表现。
我们报告一例33岁中国女性,患有左乳腺结核,并伴有双小腿前侧的结节性红斑。由于她对传统治疗的临床反应不佳,且细针穿刺细胞学检查的组织病理学结果显示有强烈的结核指征。通过聚合酶链反应对结核分枝杆菌复合群进行分子检测,证实了她的临床诊断。对结节性红斑进行的第二次聚合酶链反应检测结果为结核分枝杆菌复合群阳性,进一步证实了诊断。她接受了18个月的抗结核治疗,最后进行了残留肿块切除术。在12个月的随访检查中,未发现残留或复发疾病的迹象。
组织病理学特征和高度的临床怀疑指数对于确诊乳腺结核至关重要。抗结核治疗无论是否辅以简单的手术干预都是核心治疗方法。