Male breast cancers account for 1% of worldwide breast malignancies and are on the rise. Sri Lankan accounts are limited due to lack of healthcare seeking behavior among men. A 63-year-old male presented with a right sided hard breast lump and a Breast Imaging Reporting and Database System score 5 lesion with axillary lymph node metastasis was observed on ultrasonography. Core biopsy revealed invasive ductal breast cancer. Tumor staging revealed a T2N1M0 cancer for which mastectomy with level 2 axillary clearance was performed followed by radiotherapy and systemic therapy. Male breast cancer even though similar to female breast cancers have important distinctions with regard to molecular biology, lymphatic metastasis and age of presentation. Management; however, still relies on studies based on the female counterpart.
Background
Melioidosis caused by Burkholderia pseudomallei is an emerging infection in Sri Lanka with a high case fatality rate. The disease usually manifests as pneumonia, however multisystem involvement is common. Myositis is an extremely rare occurrence and this is the only documented case where the initial presentation of melioidosis has been myositis and later complicated to myonecrosis.
Case presentation
A 45-year-old gentleman with pre-existing diabetes presented with a tender, right thigh lump for 1 week duration without any history of trauma or infection. Investigations revealed neutrophil leukocytosis, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels whilst ultrasonography showed focal myositis of right quadriceps. The patient went into sepsis amidst antibacterial treatment which warranted urgent surgery. At surgery, a large intramuscular abscess with myonecrosis was observed within vastus medialis which was completely drained and pus was taken for culture which eventually isolated Burkholderia pseudomallei. Melioidosis was diagnosed and intravenous meropenem was prescribed for 3 weeks. Following complete recovery, the patient was discharged on doxycycline and trimethoprim sulfamethoxazole for 3 months.
Conclusions
Melioidosis, an endemic disease in south east Asia and northern Australia, is an emerging infection in Sri Lanka. Myositis is a rare presentation of the disease that can lead to myonecrosis and abscess formation which can cause rapid disease escalation and sepsis. Early surgical intervention may be life-saving in such cases where antibiotic therapy alone may not suffice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.