A rare case of nipple discharge
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A Rare Case of Nipple Discharge Prashant Kumar Singh, Shobha Joshi
Case presentation A 55-year-old non-smoker post-menopausal woman presented with milky discharge from her left nipple for two months and a history of painful blisters over left side of chest wall nine months back. She had no history of headache, vomiting, or decreased vision or other any comorbidity and did not take any medication except analgesics for the chest pain. Physical examination showed an irregular hypo pigmented atrophic patch on the anterior aspect left side of the chest wall in T5 dermatomal segment (Figure 1). Breast examination showed no asymmetry, dimpling, or masses, but did reveal milky discharge from multiple ducts in left breast. There were no systemic signs. Her routine blood picture, prolactin, thyroid function test, mammogram were within normal range.
Questions What is this condition? How do we manage this condition?
Answers 1. Post Herpes neuralgia & galactorrhoea. The history of a painful blisters and the presence of hyper pigmented atrophic scars within a dermatome (T-5) are evidence for zoster which occurred nine months prior to the development of galactorrhoea on the same side and was the possible cause, in the absence of another explanation and with normal laboratory investigations. Galactorrhea refers to the discharge of milk from the breast, and is not associated with recent childbirth or nursing. Cause of galactorrhoea
2. The management involves treatment of neuralgic pain with analgesics/carbamazepine/pregabaline etc. and local capsaicin cream/lidocaine plasters. Regarding galactorrhoea, patient should be reassured along with 6-month-follow-up along with repeat prolactin levels. Ethical Approval – Informed Consent: The authors
Table. Various causes of galactorrhoea.
Figure 1. Post Herpes atrophic scar with ipsilateral galactorrhoea. Prashant Kumar Singh, MS, MCLS, FMAS, FIAGES, MRCSEd Department of General & Minimally Invasive Surgery, PGIMER & Dr RML Hospital, New Delhi, India Shobha Joshi, MD Department of Anaesthesiology, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India Corresponding author: Dr. Prashant Kumar Singh, MS, MCLS, FMAS, FIAGES, MRCSEd Senior Resident, Department of Surgery, Room No-100, First Floor, OPD Building, PGIMER & Dr RML Hospital, New Delhi -110001, India [email protected] Received 30 Nov 2016; Accepted 22 Dec 2016
Hellenic Journal of Surgery 89
56 S. Chatterjee et al.
declare that the study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Also all patients gave their written informed consent prior to their inclusion to the study. Conflict of interest: The authors declare that there is no conflict of interest.
Hellenic Journal of Surgery 89
References 1. Jindal N, Jain VK, Aggarwal S, Kaur S. Ipsilateral galactorrhea following zoster of the T4 dermatome. Indian J Dermatol Venereol Leprol 2014;80:540-2. 2. Pena
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