Background <p>Metaplastic carcinoma of the breast (MpBC) is a rare, aggressive subtype of breast cancer characterized by combined epithelial and mesenchymal components. The simultaneous presentation of MpBC with extrapulmonary tuberculosis (TB) poses a significant diagnostic and therapeutic challenge, necessitating personalized and comprehensive management.</p> Case Presentation <p>We report the case of a patient diagnosed with MpBC located in the axillary tail, featuring histological squamoid and chondroid differentiation. The diagnosis was further complicated by the concurrent finding of a solitary liver lesion, which was confirmed as a tuberculosis granuloma (extrapulmonary TB). A multidisciplinary treatment approach was implemented to address both the malignancy and the infection simultaneously. The strategy included systemic chemotherapy for the MpBC, anti-tubercular therapy (ATT) for the liver granuloma, surgery, and radiation therapy. The comprehensive and personalized management strategy resulted in a favourable outcome for the patient, demonstrating the efficacy of integrating oncological and anti-infective treatments.</p> Conclusion <p>This case underscores the critical importance of a thorough diagnostic evaluation to identify concurrent pathologies, such as MpBC and extrapulmonary TB, and highlights the necessity of personalized treatment strategies in successfully managing complex oncological presentations.</p>