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Try out PMC Labs and tell us what you think. Learn More. Language: English French. The most common sites of herpes simplex virus HSV infection are around the oral cavity and the genitalia. However, HSV can infect any skin or mucous membrane surface.
One uncommon site of HSV infection is the breast. Reports of herpetic breast infections are predominantly cases of transmission from a systemically HSV-infected neonate to the mother during breast-feeding. A review of the literature identified only six reports suggesting HSV breast lesions acquired by means other than through an infected infant.
Of these, only one report suggests HSV transmission to the breast from a male sexual partner. A second case of clinically unsuspected symptomatic herpes mastitis presumably acquired from sexual contact in a year-old woman is presented. Herpes simplex type 1 was isolated by using polymerase chain reaction and restriction fragment length polymerization techniques.
The purpose of this report is to alert physicians to HSV mastitis. However, HSV can infect any skin or mucous membrane surface, in addition to the eyes, central nervous system and viscera. HSV skin infections are preceded by a break in the integrity of the skin, as occurs in the well documented cases of herpetic whitlow and herpes gladiatorum.
Transmission through intact skin probably does not occur 1 — 3. One uncommon site of HSV infection of the skin is the breast. Reports of herpetic breast infections are predominately cases of transmission from a systemically HSV-infected neonate to the mother during breast-feeding. A comprehensive review of the English literature identified only six reports suggesting HSV breast lesions acquired by means other than through an infected infant.
Three of these reports do not specify how the breast became infected with HSV, but the virus was either culture-proven or infected a ly healthy infant during breast-feeding 4 — 6. In one case, the virus was culture-proven and was presumably acquired by autoinoculation from an oral lesion 5.
Only one report suggests transmission of HSV to the breast from a male sexual partner with recurrent oral HSV lesions 7. We present a second case of symptomatic herpetic mastitis acquired possibly from sexual contact in a year-old woman.
Four days earlier, she had experienced pruritus and noticed a small nonspecific white lesion on the medial aspect of her left areola. She attempted to clean the area with a cotton swab, but progressive erythema and pain developed in this region over the next two days. She saw her family physician, who prescribed oral ciprofloxacin mg bid and topical bacitracin.
She failed to improve over the next 48 h and presented to the emergency department, at which time she was seen by the infectious diseases service. Further history revealed the patient to be in otherwise good health.
She denied a history of recent breast trauma or breast lesions. She had not breast-fed any of her three children. She had had a normal routine mammogram and pelvic examination the year before. She was admitted to hospital 13 years ly for depression resulting from physical and sexual abuse by her former husband. Emergency room examination revealed a 10 cm area of indurated erythema with a central 2. There was no discharge, vesicles, fluctuance, fever or axillary adenopathy.
Although the patient denied it, the appearance of the lesion strongly created suspicion that it had been inflicted by a bite. Bacterial mastitis was diagnosed, and she was treated with cefazolin 2 g intravenously every 8 h and metronidazole mg intravenously every 8 h as an out-patient two doses received. She returned to the emergency room the following day feeling unwell and unable to cope, although clinically the breast had reduced erythema and swelling. She was admitted to hospital and a surgeon was consulted because of a suspected breast abscess.
An incision and drainage were carried out the following day under general anesthetic. During surgery no abscess was discovered, but bacterial cultures and a breast tissue biopsy were obtained for histopathological examination. Complete blood count was normal and bacterial cultures were negative. However, the breast biopsy was diagnostic. By light microscopy, the epidermis was focally ulcerated and necrotic with adjacent ballooning and reticular degeneration of the epidermis forming vesicles. The epidermal-dermal interface was diffusely infiltrated by a mixed inflammatory cell infiltrate Figure 1.
A diagnosis of herpes mastitis was made and subsequently confirmed by immunohistochemistry. Hematoxylin and eosin stained section. Multinucleated giant cells and keratinocytes with intranuclear inclusions arrows diagnostic of herpes infection are present in an inflammatory background. Following protein digestion, DNA was extracted using a phenol-chloroform method and precipitated with sodium chloride-isopropanol by conventional methods.
A base pair amplification product was obtained and confirmed the presence of HSV in the breast biopsy Figure 3. Polymerase chain reaction PCR products of herpes simplex virus HSV types 1 and 2 gene after gel electrophoresis and ethidium bromide staining. This pattern confirms the presence of HSV infection in the breast biopsy. Viral typing was carried out by restriction enzyme analysis of the PCR products.
Restriction enzyme analysis following digestion of polymerase chain reaction products using Mbo 1. Lane 1 is the molecular weight control. Lane 2 shows the presence of two base pair products of respective sizes and arrows. This pattern is characteristic of herpes simplex virus type 1. The patient was discharged from hospital three days after surgery. Because the diagnosis was not suspected at the time of presentation, viral cultures and serology were not obtained and acyclovir was not offered.
Instead, antibacterial agents were continued for the incorrect diagnosis of bacterial mastitis and the mastitis resolved spontaneously over two weeks. The patient was subsequently seen for follow-up six months later and there was no recurrence or new lesions. Additional history was obtained and she denied ever having had oral or genital HSV lesions.
She was sexually active with a single partner for five years; he had no noticeable oral or genital HSV lesions. However, her former husband, who had been physically abusive, had had oral HSV lesions. Infection of the breast by HSV is uncommon. Furthermore, development of breast lesions as the first and sole manifestation of clinically apparent HSV infection without oral or genital herpes is uncommon However, oral and genital HSV infections can be asymptomatic. There is little information in the literature regarding transmission of HSV to the breast except in cases associated with neonatal breast-feeding, and because further inquiry failed to reveal the source of the herpes virus in this patient we are left to speculate as to the means of transmission.
It seems reasonable to consider three possible means of transmission in this case. One possibility is that the virus was transmitted to the breast through autoinoculation from an asymptomatic oral or genital lesion. Autoinoculation to other body sites such as face, fingers, eyes and genitalia without clinical manifestations of a primary lesion have been reported 1213but there is only one case in the literature of pd autoinoculation from known oral HSV lesion to the breast 6. Second, the patient may have acquired a subclinical infection of the breast 13 years ly from her first husband, who was known to suffer from cold sores, and the recent breast lesion was a reactivation after a long latency.
Primary infection with HSV type 1 may be subclinical 23813 ; however, primary dermal lesions are more frequently symptomatic 213 and generally associated with more severe symptoms constitutional symptoms, local adenopathy and more extensive skin lesions than with recurrences Unfortunately, because the diagnosis of herpes mastitis was not suspected, serology was not obtained from the patient at the time of admission to hospital to help distinguish this as a primary Plus size lady hsv 1 black recurrent infection.
Third, this lesion may have been a primary infection of the breast from recent sexual contact with an asymptomatic HSV carrier. Infected asymptomatic individuals can carry the virus in saliva and transmit the virus through close personal contact 213 This mode of transmission is well documented in cases of medical and dental personnel becoming infected with HSV after contact with the oral cavity of an asymptomatic carrier.
In the present case, the latter means of transmission is considered most likely. Recent sexual transmission from a partner with oral HSV infection is considered most likely because the lesion clinically looked like a bite, the patient had no personal history of HSV infection, and she had constitutional symptoms and an extensive lesion more frequently associated with primary infection than with recurrence.
Regardless of the exact mechanism by which our patient acquired the infection, the purpose of this report is to review the various modes of HSV transmission to the breast and to consider the clinical ificance of establishing the correct diagnosis. First, HSV infection should be considered in any case of ulcerating mastitis unresponsive to antibiotics.
Second, it is important to distinguish between herpes mastitis and a bacterial abscess because herpetic lesions heal spontaneously in seven to 10 days without scarring, while an abscess requires surgical drainage with residual scarring. Third, there have been two cases misdiagnosed as varicella-zoster mastitis, which were later proven by culture to be HSV infections 4. This distinction is important in counselling the Plus size lady hsv 1 black, because zoster lesions may become confluent and hemorrhagic, heal slowly with scarring, and can be associated with residual neuralgia 9.
Finally, the differential diagnosis of all maternal breast lesions should include HSV because of the potential for transmission to an otherwise healthy neonate and the potentially disastrous implications of disseminated herpes infection in the neonate. Two Plus size lady hsv 1 black the six cases of HSV breast infections reported in the literature were acquired by nonspecified means and resulted in ly healthy infants becoming fatally infected after breast feeding 67. National Center for Biotechnology InformationU.
Can J Infect Dis. Author information Article notes Copyright and information Disclaimer. Telephonefaxe-mail ac. Received Oct 3; Accepted Dec All rights reserved. This article has been cited by other articles in PMC. Abstract The most common sites of herpes simplex virus HSV infection are around the oral cavity and the genitalia. Keywords: Breast infection, Herpes simplex virus, Polymerase chain reaction, Restriction fragment length polymerization.
Open in a separate window. Figure 1. Figure 2. Figure 3. Figure 4. Herpes simplex of the nipple: infant to mother transmission. Am Fam Physician. Selling B, Kibrick S. An outbreak of herpes simplex among wrestlers. N Engl J Med. Haynes RE. The spectrum of herpes simplex virus infections in children. South Med J. Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adults. Am J Med. Cytologic detection of herpes simplex virus DNA in nipple discharge by in situ hybridization. Diagn Cytopathol. The natural history of herpes simplex virus infection of mother and newborn.
Disseminated neonatal herpes simplex virus type 1 from a maternal breast lesion. Histopathology of the Skin. Philadelphia: JB Lippincott Co; Hood AF. Viral diseases. Pathology of the Skin. Englewood Cliffs: Prentice Hall;Plus size lady hsv 1 black
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