IntroductionTuberculosis is a chronic granulomatous infection caused by Mycobacterium tuberculosis (MTB). It is a common disease in low- and middle-income countries of the world. Tuberculosis (TB) primarily affects the lungs but can also affect other organs (extra-pulmonary) such as the lymph nodes, genitourinary system, bones and joints, gastrointestinal system, central nervous system, and spine.Breast tuberculosis (BTB) was first described by Sir Astley Cooper in 1829 [1, 2]. It’s characterized by granulomatous inflammation of the breast parenchyma, which may present with cutaneous manifestations including skin changes and ulceration. The breast is a rare site of manifestation of extra-pulmonary tuberculosis, especially as a primary manifestation, even in tuberculosis-endemic countries [3-6]. It generally affects women of reproductive age, commonly between 21 and 30 years old [3, 4, 6, 8, 10].The incidence of BTB is estimated to account for 0.1% of breast diseases in developed countries but reaches 3% to 4.5% in endemic countries [3, 6, 7, 9, 10]. The factors thought to be responsible for the higher incidence of the disease in the developing world include HIV/AIDS, an increase in the prevalence of multi-drug-resistant tuberculosis, and the increasing age of lactating women [5, 11].The clinical presentation of BTB is often insidious and non-specific, mimicking the signs of breast carcinoma. It can present as a breast abscess, a unilateral painless mass, or a sinus and it may sometimes mimic breast cancer [10]. Clinically and radiologically, BTB can resemble a pyogenic breast abscess, fibroadenoma, or carcinoma. The most concerning differential diagnosis is carcinoma of the breast because of the inherent consequences of the treatment, including chemotherapy. The role of microbiology tests in the diagnosis of BTB is, therefore, paramount. Histologic confirmation requires demonstration of acid and alcohol fast bacilli (AAFB), GeneXpert, culture, or polymerase chain reaction (PCR) as means of identifying the causative mycobacterial organism.This report illustrates a case of GeneXpert-confirmed BTB encountered in a tertiary hospital in Ethiopia and highlights the salient features that may aid in diagnosis.