Secreting Male Breast: A Clinical Oddity

A 34-year-old male who had been diagnosed with pulmonary tuberculosis 5 months ago and was started on National TB Elimination Program (NTEP) standard regimen-based antitubercular therapy came for Outpatient consultation regarding new onset swelling and discharge from bilateral breasts for the last 15 days. On clinical examination, he was found to have bilateral gynecomastia. Routine and hormone laboratory investigations were performed to rule out other causes, and isoniazid exposure was determined to be the underlying cause. The patient was allowed to complete his course of antitubercular therapy (ATT) which was simultaneously managed with pyridoxine supplementation. On follow-up 2 months after completion of ATT, the gynecomastia decreased significantly, and there was no discharge either. It is highly unusual for a male patient to develop a fully functional gynecomastia following isoniazid exposure. There is no guideline-directed management for this condition, and rapid resolution following pyridoxine supplementation encourages its use in future cases.