Axillary Lymphadenopathy with Bilateral Nipple Discharge: A Case Report
Panithan Santibhavank, M.D.

ABSTRACT
We present a probable case of tuberculous lymphadenitis and mastitis in Sawan Pracharak
Hospital, Nakhon Sawan, Northern Thailand. A 59-year-old single female was found to have an enlarged left axillary lymph node of 2 cm in size detected during a physical check-up. She had a history of paleyellow serous discharge from both nipples off and on for 2-3 months. She had no chronic disease and was taking no medications. Fine needle aspiration and excisional biopsy of the lymph node revealed reactive hyperplasia. Two and a half years later, she noted an enlarged right axillary lymph node of 1.5 cm in size. A pathological section showed caseous granuloma with negative acid-fast bacilli (AFB) staining. She was
diagnosed with tuberculous lymphadenitis and mastitis, and empirically treated with a standard short-course of anti-tuberculosis therapy. She was seen for the last time one year after treatment discontinuation without any symptoms and signs of relapse.
Tuberculous lymphadenitis in association with mastitis is rare. The diagnosis usually depends on the pathological examination. The negative result of AFB staining of the lymph node and nipple discharge does not exclude tuberculosis. Tuberculosis should be considered in the differential diagnosis of patients who present with axillary lymphadenopathy with or without nipple discharge, especially in the endemic areas of tuberculosis.