Gynaecomastia with oligospermia: an unusual complication of low-dose methotrexate for pustular psoriasis.

Abstract

Conflict of interest: none declared. Gynaecomastia, a benign enlargement of male breast due to proliferation of glandular tissue, is a common condition. Pathological cases are the result of renal, hepatic, nutritional or endocrine dysfunction or as a side‐effect of some drugs.1 Low‐dose methotrexate (Mtx) has been documented to cause gynaecomastia in seven rheumatic patients to date.2 However, despite its widespread and prolonged use for treatment of psoriasis and other dermatoses, no mention of this complication exists in the dermatology literature.3 A 50‐year‐old man weighing 55 kg with no pathological history of interest was diagnosed with pustular psoriasis. Mtx therapy at an oral dose of 20 mg weekly, led to clearance of the lesions after 8 weeks. Four months later, he complained of bilateral, tender breast enlargement without nipple discharge. He denied change in libido, body hair, erectile function, or testicular size, or intake of alcohol or marijuana. Evaluation revealed mildly atrophic, nontender testes and bilateral breast enlargement of 5 cm without nodules or surface changes (Fig. 1). Fine‐needle aspiration cytology from the breast lump confirmed presence of glandular tissue without features of atypia. Thyroid and renal function tests (serum creatinine 8 mg/L), liver enzymes and hormonal profile (Table 1) were normal. Semen analysis showed opaque semen of 0.5 mL volume with total sperm count of 15 × 103/mL, motility in 5% and morphological abnormality in 15%.