Abstract:

Objective: To report the clinical diagnosis and management of one case of AIDS complicated with rifampicin-resistant tuberculous breast abscess, enhance understanding of the diagnosis and treatment of drug-resistant extrapulmonary tuberculosis in immunocompromised hosts, and analyze the clinical features, imaging characteristics and prognosis of tuberculous breast abscesses in confuction with a literature review, thereby providing evidence-based guidance for clinical differential diagnosis and the selection of treatment regimens. Methods: A retrospective analysis was conducted on the clinical diagnosis and management of a patient with AIDS complicated with rifampicin-resistant tuberculous breast abscess. Case reports of patients with tuberculous breast abscesses were retrieved from databases including CNKI, Wanfang Data, Chinese Journal Full-text Database, and PubMed using the keywords “tuberculous breast abscess” “AIDS/HIV” “rifampicin resistance” “imaging”, and “molecular detection techniques” for the period from October 2019 to June 2025. The clinical features, imaging characteristics, and prognostic outcomes of tuberculous breast abscesses were combined with the present case. Results: This patient was a 36-year-old woman with a 6-year history of HIV infection who was admitted to Yunnan Provincial Infectious Disease Hospital presenting with a 9-year history of a nodule in the left breast and more than 3 months of distension and pain in the right breast. Right breast ultrasound, CT scan and pus GeneXpert MTB/RIF testing revealed, Mycobacterium tuberculosis (MTB) positive with a mutation at the His526Tyr site of the rpoB gene confirming the diagnosis of rifampicin-resistant tuberculous breast abscess. After 11 months of treatment with a bedaquiline-containing short-course, all-oral regimen (6Bdq-Lfx-Lzd-Cs-Cfz/5Lfx-Lzd-Cs-Cfz) in combination with standard antiretroviral therapy, the lesions gradually resolved. A literature review identified nine cases of tuberculous breast abscess, none of whom were complicated with HIV infection. An analysis of these 10 patients, including the present case, revealed that 7 cases were reported in the international literature; 9 were female, of whom 7 were women of childbearing age (31-40 years), and 1 was a 77-year-old male. Clinical manifestations were predominantly breast masses, swelling and pain, or cold abscesses; some cases presented with ulceration or sinus tract formation; unilateral involvement was more common (7 cases). Ultrasound, CT or MRI scans typically revealed hypoechoic or mixed-echo lesions, thickened walls, internal debris or annular enhancement,but all lacked specific findings. Delayed diagnosis was reported in 8 cases, of which 2 were initially misdiagnosed as suppurative mastitis or breast cancer, and 6 had an unclear diagnosis. Pathological confirmation was obtained in 5 cases, and MTB was confirmed by microbiological testing in 5 cases. All 9 retrieved cases were treated with the drug-sensitive regimen “H-R-Z-E”. Three cases were cured, and 7 cases showed improvement in clinical symptoms and imaging findings after completion of treatment. Conclusion: Tuberculous breast abscesses are most commonly seen in women of childbearing age and lack specific clinical and imaging features, resulting in high rates of misdiagnosis and delayed diagnosis. Molecular testing and histopathological examination hold significant value for early diagnosis and drug resistance screening in such patients. Standardised anti-tuberculosis treatment can markedly improve patient prognosis. When breast nodules or abscesses present with disseminated or atypical manifestations in the context of HIV infection, and show poor response to general anti-infective therapy, tuberculosis should be actively considered. A good prognosis can still be achieved through standard anti-tuberculosis and antiviral treatment, provided that drug interactions are managed appropriately.

Key words: Tuberculosis, Mastitis, Rifampin, Drug resistance, bacterial, Acquired immunodeficiency syndrome