Mammary tuberculosis is a rare clinical entity, often mimicking breast cancer or abscesses. A 26-year-old female presented with a painful left breast mass and an associated sinus tract with purulent discharge. Physical examination revealed a tender, erythematous, firm left breast mass with an associated sinus tract opening with discharge within the upper outer quadrant of her left breast with a clinically palpable left axillary lymphadenopathy. Ultrasound revealed nonspecific findings and mammography could not utilize due her young age. A surgical procedure was planned and the left breast mass was completely removed by an open surgical biopsy including left axillary lymphnodes and the hystopathological evaluation of the specimen revealed findings consistent with mammary tuberculosis whereas no other nidus for tuberculosis were found within the organs including lungs. Primary mammary tuberculosis should be considered in the differential diagnosis of any case of a painful breast mass that appears refractory to conventional therapy.