Friday, October 9, 2020

Internship diaries: Perception of nipple discharge

A 60-year-old female complained of clear discharge from her right breast for one week. 

On examination, the right breast nipple was painful and there was clear fluid around the nipple. Expressing the breast produced no discharge. Incidentally, she mentioned a rash that was hurting on her right shoulder. The rash was a distinctive cluster of fluid-filled blisters with inflamed underlying skin, suggestive of shingles. 
Then on a closer look, we realized she had minute vesicles on her nipple which were perceived by the patient as nipple discharge. She had Herpes Zoster that affected her nipples!

Patients are treated for shingles only if they are within 72 hours of presentation. In immunocompromised patients, treatment can be offered beyond the 72 hour period. As this patient was 60 years of age, the physician found it appropriate to start her on anti-viral medication. A mammogram was also ordered to rule out breast cancer.

Treatment for shingles is as follows:
Acyclovir 800 mg 5 times a day for 7 days
or Valacyclovir 1000mg 3 times a day for 7 days
or Famicyclovir 500mg three times a day for 7 days

Written by Tasneem Adenwala

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