CASE
A 56 year old man presented at the routine HIV outpatient clinic with
complaints of left and right breast discomfort for about six months
followed by gradual swelling of the left breast. He did not report any
change in body hair, libido or erectile dysfunction. Discomfort was
described as pins and needles, no itchiness, no discharge from the
nipples or skin changes were reported. He had no previous breast
problems, but his mother had a history of breast cancer.
He was known to the HIV service and had been living with HIV since 2001.
Previous antiretroviral treatment combinations include: stavudine +
lamivudine + efavirenz and zidovudine + lamivudine + efavirenz. Due to
progressive multifocal leukoencephalopathy, he was kept on zidovudine +
lamivudine + nevirapine + abacavir. In 2010, he transferred to our care
and was prescribed tenofovir + emtricitabine + nevirapine until 2017
when his treatment was changed to include an integrase inhibitor,
raltegravir (RAL) alongside tenofovir + emtricitabine. However, due to
intolerance to RAL, he was switched back to tenofovir + emtricitabine +
nevirapine in 2018. In June 2022, he opted for the injectable
combination of cabotegravir/rilpivirine to allieviate the anxiety around
daily HIV medication intake. He showed adherence to injection
appointments and remained virologically suppressed.
His current co-morbidities included well controlled hypertension,
hyperlipidaemia, non-obstructing calculi of the right kidney, benign
prostate hyperplasia and a recurring reducible left inguinal hernia. His
previous co-morbidities were left hernia repair, progressive multifocal
leukoencephalopathy with peripheral neuropathy, hypogonadism and
hypothyroidism. His current co-medications were atorvastatin,
solifenacin, ramipril, tadafil, multivitamins and probiotics. He is a
non-smoker and drinks alcohol occasionally. He works as a personal
trainer and is usually very active with no history of anabolic steroid
use.
On physical examination, he appeared well. His body mass index was 27.35
kg/m2, blood pressure 144/91mmHg and other vital signs were in normal
range. He had bilateral, sub-areolar, concentric breast masses, with
palpable nodules that were soft and mobile. There was tenderness on
palpation with no nipple discharge or axilla lymphadenopathy. His
hormonal blood workup was within normal range, . We suspected him to
have idiopathic gynecomastia and we referred him to the breast clinic
for further evaluations as well as to rule out pseudo-gynecomastia and
breast cancer.