Background <p>Multidrug-resistant tuberculosis (MDR-TB) remains a major global public health challenge, whereas extrapulmonary involvement is relatively uncommon. Here, we report a rare case of disseminated MDR-TB presenting with simultaneous involvement of multiple organs. A review of the literature identified a single previously reported case of MDR-TB of the breast and six cases involving the female reproductive system, and none exhibited a pattern of organ involvement or microbiological characteristics comparable to those observed in the present case.</p> Case presentation <p>A 33-year-old woman presented with a five-month history of breast swelling and pain, accompanied by fever for three days. Microbiological testing confirmed disseminated MDR-TB with simultaneous involvement of the lungs, breast, and adnexa uteri. The patient showed marked clinical improvement following individualised, guideline-based anti-tuberculosis therapy.</p> Conclusion <p>This case highlights the exceptional rarity of MDR-TB with atypical multi-organ involvement and underscores the importance of maintaining high clinical suspicion for tuberculosis in uncommon sites. Early implementation of comprehensive microbiological and drug resistance assessments, followed by appropriate standardised therapy, is essential to prevent diagnostic delay and improve clinical outcomes.</p>