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Updated: Oct 24, 2025

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Fatema A J AbdulKarim1, Safwat M Ibrahim2, Arnold Ad Hill1
1Royal College of Surgeons in Ireland.
This case report describes a rare occurrence of ochronosis in the breasts and chest wall of a woman. Ochronosis is a condition caused by a rare genetic disorder called alkaptonuria. The syndrome is marked by a buildup of a specific acid in the body, leading to dark pigmentation in tissues. While skin and joint involvement is typical, breast involvement is uncommon. The patient showed bluish-black discoloration in both breasts and the chest wall. Urine tests confirmed the presence of the acid, and enzyme testing showed a deficiency. The authors highlight the rarity of this presentation and stress the importance of recognizing unusual symptoms in diagnosis.
Area of Science:
Background:
Ochronosis is a rare condition caused by the accumulation of homogentisic acid in tissues. It is typically linked to alkaptonuria, an inherited metabolic disorder. The syndrome is marked by a triad of symptoms: skin pigmentation, cartilage discoloration, and dark urine. The enzyme deficiency responsible is homogentisate 1,2-dioxygenase. While skin and joint involvement is common, breast involvement is exceptionally rare. Prior research has shown that the condition affects connective tissues broadly. No prior work had resolved the occurrence of bilateral breast ochronosis. This gap motivated a closer look at unusual manifestations.
Purpose Of The Study:
This case report aims to document an unusual presentation of ochronosis. The patient presented with discoloration of both breasts and the chest wall. The authors sought to highlight the rarity of breast involvement in alkaptonuria. The motivation stems from the lack of documented cases in this region. Documenting such cases can aid in diagnosis and awareness. The study does not propose new treatments or mechanisms. It focuses on the clinical presentation and implications. The goal is to contribute to the existing literature on rare manifestations.
Main Methods:
The authors conducted a case report based on a single patient's clinical presentation. They reviewed medical records and performed a physical examination. The diagnosis was confirmed through urine analysis and enzyme activity testing. The patient's history was analyzed for signs of alkaptonuria. The study does not involve experimental testing or controlled trials. The approach is descriptive and observational. The focus is on clinical documentation and patient history. The findings are presented in the context of known literature.
Main Results:
The patient exhibited bluish-black pigmentation of both breasts and the chest wall. Urinalysis confirmed homogentisic aciduria. Enzyme activity testing showed a deficiency in homogentisate 1,2-dioxygenase. The skin and cartilage showed typical ochronotic changes. The case is notable for the bilateral involvement of the breast tissue. No prior work had resolved such a presentation in the literature. The authors emphasize the diagnostic challenge posed by this case. The findings align with known characteristics of alkaptonuria.
Conclusions:
The authors conclude that ochronosis can manifest in unusual locations such as the breast. The case highlights the importance of considering rare conditions in differential diagnosis. The findings align with established knowledge of alkaptonuria. The authors do not propose new treatment strategies or mechanisms. The report contributes to the understanding of rare clinical presentations. The case underscores the variability of ochronosis manifestations. The authors emphasize the need for awareness among clinicians. The study does not suggest broader implications beyond the case presented.
The case report documents a rare instance of bilateral breast ochronosis in a patient with alkaptonuria.
The diagnosis was confirmed through urinalysis showing homogentisic aciduria and enzyme activity testing.
Breast involvement is rare; typical manifestations include skin, cartilage, and joint discoloration.
It confirmed a deficiency in homogentisate 1,2-dioxygenase, supporting the diagnosis of alkaptonuria.
The pigmentation aligns with known ochronosis features but is uncommon in this anatomical region.
The authors emphasize the need for clinicians to consider rare presentations in differential diagnosis.