Gynaecomazia in a HIV, Hepatitis B and C affected middle aged male: a case report

Ajay Kumar, Sarada Khadka, Shailesh Adhikary


Gynaecomazia is benign proliferation of male breast tissue. Asymptomatic gynaecomazia has a trimodal age distribution, occurring in neonatal, pubertal, and elderly males causing considerable anxiety to the patients. Although it is a common disease but its presentation in middle age is rare, which demands thorough investigations to look for underlying cause. The patient 42-year gentleman presented with bilateral enlarged breasts gradually progressive for two years. He did not experience any pain or discharge from nipples. He was an intravenous drug abuser, and has had pulmonary tuberculosis treated 14 years back. He also had infection by human immunodeficiency virus for nine years and was treated with anti-retroviral therapy. He was also tested positive for HBsAg and anti-HCV. To best of literature search, we could find only few case reports related to gynaecomazia in Nepal, neither from eastern region nor as a side effects of drugs. Also, gynaecomazia related to ART or anti-tubercular drugs were reported within few months or a year of commencement of therapy. Similarly, cases with multiple risk factor exposure have not been often reported.


ART, Gynaecomazia, HIV, Hepatitis C

Full Text:



Braunstein GD. Gynecomastia. N Engl J Med. 2007;357(12):1229-37.

Kumar R. A Clinicopathologic Study of Breast Lumps in Bhairahwa, Nepal. Asian Pacific J Cancer Prev. 2010:(11);855-8.

Johnson RE, Murad H. Gynecomastia: Pathophysiology, Evaluation, and Management. Mayo Clin Proc. 2009;84(11):1010-5.

Piroth L, Grappin J, Petit M, Buisson M, Duong M, Chavanet P, Portier H. Incidence of gynecomastia in men infected with HIV and treated with highly active antiretroviral therapy. Scand J Infect Dis. 2001;33:559-60.

Kwekwesa A. Breast enlargement in Malawian males on the standard first-line antiretroviral therapy regimen: case reports and review of the literature. Malawi Med J. 2015;27(3):115-7.

Meerkotter. Gynaecomastia associated with highly active antiretroviral therapy (HAART). Radiol Case. 2010;4(7):34-40.

Biglia A, Blanco JL, Martínez E, Domingo P, Casamitjana R, Sambeat M, et al. Gynecomastia among HIV-infected patients is associated with hypogonadism: a case-control study. Clinic Infect Dis. 2004;39(10):1514-9.

Njuguna C, Swart A, Blockman M, Maartens G, Chisholm B, Stewart A, et al. Cases of antiretroviral-associated gynaecomastia reported to the National HIV and Tuberculosis Health Care Worker Hotline in South Africa. AIDS Res Therap. 2016;13(1):40.

Biglia A. Gynecomastia among HIV-infected patients is associated with hypogonadism: a case-control study. Clin Infect Dis. 2004;39:1514-9.