Tuberculosis (TB) of the breast remains a rare entity that commonly leads to disseminated cold abscesses and the spread of infection, especially in endemic regions like India. Its presentation, a firm nodule, with or without pain leading to ulceration and discharge, mimics various mammary pathologies, including malignancy, mycotic abscesses and granulomatous mastitis, and is, therefore, easily misdiagnosed. We present a case of primary TB of the breast with an abdominal cold abscess in a patient who complained of ulceration in the left breast, having a previous four-year history of a breast lump. Purulent discharge from the ulceration and abscess was positive for TB in a Cartridge-Based Nucleic Acid Amplification Test. She was also incidentally found to have a cold abscess in the superficial fascia in the left iliac fossa. The patient was treated with antitubercular drugs under the National TB Elimination Program. She is currently in her fourth month of treatment and has experienced a resolution of symptoms.
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