Unilateral Nipple Inflammation with Discharge in a 35-Year-Old Male

Case at a Glance

A 35-year-old Asian male presented with acute onset left nipple inflammation, pain, and yellowish discharge following intimate contact. Patient has a history of finasteride use and comorbid diabetes and hypertension.

Patient's Story

The patient noticed left nipple inflammation and tenderness 5 days prior to presentation while showering. He observed a yellowish crystalline discharge described as resembling dried plasma or scab formation. The symptoms developed acutely without prior episodes. He reported recent intimate contact involving bilateral nipple stimulation. Concerned about the appearance and potential serious underlying pathology, he discontinued his finasteride therapy suspecting possible gynecomastia-related complications. At time of consultation, he reported persistent inflammation and pain without active bleeding or discharge.

Initial Assessment

Physical examination revealed unilateral left nipple erythema, swelling, and tenderness to palpation. Evidence of prior yellowish discharge with crusting was noted. No active bleeding or purulent discharge observed at time of examination. Bilateral breast examination showed no palpable masses or lymphadenopathy. No signs of systemic infection were present.

The Diagnostic Journey

Given the acute onset following intimate contact and clinical presentation, the primary differential diagnosis included traumatic nipple injury with secondary inflammation, possible bacterial infection, or contact dermatitis. The patient's concern about gynecomastia secondary to finasteride use was noted but deemed unlikely given the unilateral acute presentation. Laboratory workup and imaging were considered based on clinical response to initial management.

Final Diagnosis

Acute traumatic nipple inflammation with secondary irritation, likely related to mechanical trauma during intimate contact.

Treatment Plan

Conservative management with topical antiseptic care, warm compresses, and analgesics for pain control. Patient counseled on gentle hygiene practices and avoiding further mechanical irritation. Antibiotic therapy considered if signs of secondary bacterial infection develop. Follow-up arranged within one week to assess healing progress.

Outcome and Follow-up

Patient advised to monitor for signs of infection including increased redness, warmth, purulent discharge, or systemic symptoms. Reassurance provided regarding the benign nature of the condition with appropriate care. Education given about preventing similar injuries during intimate activities. Finasteride discontinuation discussed as unnecessary given the likely traumatic etiology rather than hormonal cause.