Darwish et al. Journal of Medical Case Reports 2010, 4:267 http://www.jmedicalcasereports.com/content/4/1/267 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Cyclosporine-A therapy-induced multiple bilateral breast and accessory axillary breast fibroadenomas: a case report Ahmed Darwish1, Ayman O Nasr1*, Lamya A El Hassan2, Ahmed H Fahal1 Abstract Introduction: Breast adenoma is common. However, in the setting of post-transplantation immune suppression it may be expressed differently. Case presentation: A 35-year-old Sudanese woman, with a history of renal transplantation two and half years prior to presentation, was on a single immune suppression therapy in the form of cyclosporine-A since the transplantation. During a regular follow-up visit, she was noticed to have gingival hypertrophy and bilateral breast and axillary swellings. She underwent successful surgical resection of the bilateral fibroadenomas. Conclusions: Cyclosporine-A therapy post renal transplantation is associated with an increased incidence of benign breast changes as fibroadenoma. Regular follow-up and appropriate selection of immunosuppressant therapy are essential in the post transplantation management of these patients. Introduction The presence of bilateral breast fibroadenoma is rare. To the best of our knowledge, there are no previous reports of bilateral breast fibroadenoma associated with accessory axillary breast fibroadenoma in the English medical literature. We present the case of a woman with bilateral breast fibroadenoma secondary to cyclosporine- A therapy post renal transplantation. Case presentation A 35-year-old Sudanese woman presented to the Surgi- cal Out-patient Department at Soba University Hospital, Khartoum, Sudan with bilateral breast and axillary swel- lings. Her condition started one year prior to presenta- tion with a small painless right breast lump slowly increasing in size. It was not considered necessary by our patient to report it during her regular follow-up until seven months later when she noticed multiple small painless nodules on the left breast. She mentioned these lumps to the nephrologist in the following visit. There was no nipple discharge, local skin changes or * Correspondence: aomnasr@hotmail.com 1P.O. Box 102, Department of Surgery, Faculty of Medicine, University of Khartoum, Sudan Full list of author information is available at the end of the article variation in size with menstruation. One month later she noted bilateral painless axillary swellings that started to increase in size. Our patient was diagnosed with end-stage renal failure of unidentified etiology three years prior to presentation. She underwent regular hemodialysis sessions before kid- ney transplantation two years prior to presentation. Her post-operative recovery was uneventful and she was commenced on cyclosporine-A (175 mg/day). She con- tinued to attend regular follow-ups post transplantation. After two years of follow-up, she was found to have gum hypertrophy with no associated pain, bleeding or oral complains. Her menarche was at the age of 16. She had a regular menstrual cycle and unremarkable adolescence. She had normal breast development, with no past or family his- tory of breast disorders. She never used contraceptive pills. General examination was satisfactory. Oral examina- tion confirmed upper and lower gingival hypertrophy with congestion, good oral hygiene and no ulceration or bleeding spots. There was bilateral accessory axillary breast tissue. Right breast examination revealed a 20 cm mobile firm non-tender mass. Examination of the left breast revealed multiple mobile masses not more than © 2010 Darwish et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.