Infectious Disease · Dermatology · General Practice · 2 h ago
Borrelial Lymphocytoma Presenting as Nipple Swelling in an Adult Man
A case report describes a man in his 40s with two months of unilateral nipple swelling and tenderness. Biopsy showed reactive lymphoid hyperplasia, and the patient improved after a 14-day course of doxycycline; markedly elevated Borrelia IgG supported the suspected diagnosis.
- Unilateral nipple swelling led to biopsy and Borrelia testing.
- Biopsy showed reactive lymphoid hyperplasia, not lymphoma.
- The patient improved after 14 days of doxycycline.
- Borrelial lymphocytoma can affect adult nipples.
A man in his 40s presented with more than two months of swelling and tenderness in the right nipple. Examination found no signs of infection, local irritation or palpable axillary lymph nodes. Mammography showed an enlarged nipple and mild areolar skin thickening, without gynecomastia. Ultrasound confirmed the swelling, and a punch biopsy was performed to investigate the lesion.
Histology showed a lymphoid infiltrate with a slight predominance of small B cells. Immunohistochemistry and PCR clonality testing found no evidence of lymphoproliferative neoplasia, and the findings were interpreted as reactive lymphoid hyperplasia. Borrelia IgG was markedly elevated and IgM was negative. The patient received oral doxycycline 100 mg twice daily for 14 days; the nipple rapidly improved and was normal after treatment.
The authors considered borrelial lymphocytoma, a rare cutaneous manifestation of Lyme borreliosis that may appear on the nipple in adults weeks or months after a tick bite. They note that serology may reflect previous exposure and that biopsy can help exclude lymphoma or other malignancy when the diagnosis is uncertain. Clinicians should also consider possible concurrent neuroborreliosis. This is a single case and does not establish diagnostic test performance or treatment effectiveness.
In practice
In adults with persistent nipple swelling or an atypical areolar lesion, borrelial lymphocytoma is a rare diagnostic possibility, even without a recalled tick bite or erythema migrans. This case illustrates use of clinical assessment, Borrelia serology and biopsy; tissue examination helped exclude lymphoproliferative neoplasia. However, IgG may reflect previous exposure, and improvement after doxycycline in one patient does not establish treatment effectiveness. The authors also advise awareness of possible concurrent neuroborreliosis.
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