Bloody niple discharge in infants, case report in a male toddler

Bloody nipple discharge in infants is an infrequent clinical finding and is associated with benign etiologies.

To report a case of bloody nipple discharge in an older infant with gynecomastia and discuss the clinical decision-making in relation to this symptom.

A 13-month-old male infant who presented with a one-month history of three episodes of bilateral bloody nipple discharge, with no other associated symptoms. He was exclusively breastfed until 6 months of age and afterwards with breastfeeding and complementary feeding until the day of consultation, without history of exposure to endocrine disruptors. Physical examination revealed gynecomastia with Tanner stage 3 of breast development. No abnormalities in his growth chart were noted. Upon breast compression, dark red blood came out of the right nipple, and brownish fluid from the left one. Breast ultrasound showed a simple cyst in the right breast. The clinical and radiological findings were attributable to ductal ectasia. An expectant management approach was adopted, and spontaneous resolution occurred within two months of onset. There was no clinical recurrence after nine months of follow-up.

The most common etiology of bloody nipple discharge in pediatric patients is ductal ectasia; however, it can be secondary to breast cysts, intraductal papilloma, fibroadenomas, and mastitis. Current literature recommends an expectant management approach with follow-up until resolution, with no need for further procedures.