Rusty Pipe Syndrome: First Case Report from a Nigerian Lactating Mother

doi:10.21203/rs.3.rs-5159431/v1

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Case Report

Rusty Pipe Syndrome: First Case Report from a Nigerian Lactating Mother

https://doi.org/10.21203/rs.3.rs-5159431/v1

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Background

Rusty pipe syndrome is a rare medical condition seen in late pregnancy or early lactation, which may affect successful breastfeeding despite being benign and self-limiting. Although rare, RPS can cause significant concern for mothers, caregivers, and healthcare providers. Thus, we highlight this case report in a Nigerian lactating mother

Case presentation

A 24-year-old first-time mother delivered an infant with a birth weight of 3000 g via spontaneous vaginal delivery at 38 weeks of gestation. While attempting to breastfeed her baby, the mother experienced painless bilateral bloody nipple discharge. Physical examination of her breasts revealed that they were unremarkable. Breast ultrasonography and cytological analysis of the discharge revealed no signs of neoplasm. The bloody discharge resolved spontaneously over 72 hours, and she continued to breastfeed her baby exclusively.

Conclusion

Rusty pipe syndrome is a benign, self-limiting condition that should be considered in the differential diagnosis of bloody nipple discharge. Awareness of this rare disease among medical healthcare workers would be extremely beneficial and help ensure successful breastfeeding.

Rusty Pipe Syndrome

Bloody Nipple Discharge

Lactating mother

Breastfeeding remains the natural and safest source of nutrition for infants, providing essential nutrients and antibodies from birth [1]. Typically, the breast milk color ranges from light orange to pale gray, with any unusual coloration raising concerns for the mothers and healthcare workers, which may impact the success of breastfeeding [1, 2]. One of the rare color changes, especially in a lactating mother, is bloody nipple discharge, which may cause significant anxiety, the need for medical evaluation, and possible intervention [2]. However, blood nipple discharge in a lactating mother may be due to “rusty pipe syndrome,” also referred to as brown or rusty-pipe colostrum, a benign-self-limiting clinical condition. This condition manifests as bloody nipple discharge during pregnancy or early lactation, which can be mistaken for a pathological issue and affects the success of breastfeeding [3, 4]. Rusty pipe syndrome is a rare medical condition, with few case reports in the literature among lactating women and none from Nigeria [2, 3, 4]. Thus, this case report highlights a 24-year-old primiparous woman with bloody nipple discharge after delivery that resolved spontaneously within 72 hours. We highlight this case to raise awareness among healthcare providers, prevent undue concerns, and ensure appropriate management.

A 24-year-old first-time mother delivered a baby boy at 38 weeks’ gestation via spontaneous vaginal delivery. She attempted to breastfeed her baby shortly after delivery but observed that the baby vomited each time. Additionally, she noticed bilateral painless, bloody nipple discharge while expressing her milk, which was more pronounced in the left breast. The expressed breast milk was dark brown in color (Fig. 1). She denied experiencing any infection or trauma and had no family history of breast disease. Physical examination of her breasts showed no signs of inflammation, engorgement, tenderness, or palpable masses. The nipples were erect without cracks, ulcers, or fissures.

Examination of the newborn revealed unremarkable findings. We temporarily discontinued breastfeeding and advised the mother to express breast milk every three hours to prevent engorgement. A sample of breast milk was sent for cytological analysis, which did not show any malignant cells. Ultrasound of the breasts revealed a bilateral generalized background cotyledon-like echogenic appearance with no ductal lesions or enlarged axillary lymph nodes, and cytology showed foamy macrophages (Fig. 2). During hospitalization, the color of the milk changed from dark brown to light brown (Fig. 3), and finally resolved spontaneously over 72 hours after delivery, with no recurrence (Fig. 4). The infant was initially formula fed but was switched to exclusive breastfeeding from the fourth day of life until date (the baby is now two months old).

Although rare during pregnancy, blood-stained nipple discharge can cause significant anxiety due to its association with breast cancer in non-pregnant individuals [2, 3]. Rusty pipe syndrome (RPS) is one of the rare physiological changes seen during late pregnancy and early lactation, a benign and self-limiting condition characterized by painless, bloody, or brown discharge [2, 3]. Nipple discharge in RPS is due to the proliferation of ductal epithelium and the fragility of the capillary network surrounding mammary ducts, which can be easily damaged due to hormonal influences from estrogen, progesterone, and oxytocin, leading to blood cell leakage into breast secretions [2, 3].

There are only a few case reports of RPS, with approximately 16 cases in the literature and none from Nigeria [ 2,3,4,5,6,7,8,9,10,11,12]. This confirms the rarity of the clinical condition, with most occurring in first-time mothers, which could be a source of concern and potentially affect breastfeeding. This finding suggests the need to raise awareness of the clinical condition and ensure adequate maternal support.

In this case, bloody discharge was noted shortly after birth (an hour after birth). This is consistent with observations in the literature, where RPS typically manifests during the second or third trimester or the lactation period. In contrast to our observation, a case report documented RPS in a 22-year-old woman at 26 weeks of gestational age [10]. Being a painless condition, it is often noticed when the mother expresses breast milk or the infant vomits after feeding [ 2,3,4,5,6,7,8,9,10,11,12]. In cases where it is noticed when the mother expresses the milk, breastfeeding is encouraged if the infant tolerates it to encourage lactation. However, if the infant, as in our case, does not tolerate breastmilk, we recommend close monitoring of milk during expression until the color improves, and breastfeeding is resumed as soon as possible. This is because bloody discharge usually resolves spontaneously within 7–10 days with no adverse effects on maternal or neonatal health. Comparable to the report from India, our patient experienced complete resolution within 72 hours [7]. Following the spontaneous resolution in our case, we counseled the mother on its benign nature and encouraged her to continue breastfeeding. We scheduled further follow-up and found no abnormalities in the mother, and she continued to exclusively breastfeed her baby.

Rusty Pipe Syndrome is a rare benign clinical condition that healthcare workers need to be aware of and may cause significant concern for mothers and healthcare providers, though it typically resolves spontaneously within days. Raising awareness among healthcare professionals about RPS is crucial for providing proper counseling and management, thereby preventing unnecessary anxiety and medical interventions for the affected mothers.

RPS

Rusty Pipe Syndrome

Ethics approval and consent to participate

Not applicable

Consent for publication

The patient signed a written informed consent for this publication and remained anonymous.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Competing interests

The authors declare that they have no competing interests.

Funding

This study is self-sponsored and there was no grant support.

Author Contributions

FMA conceptualized the study, curated data, conducted the literature search, drafted the manuscript, critically appraised the manuscript and approved the final version. OGI was involved in conceptualization, data curation, literature search, drafting, and approval of the final version. OSO contributed to data curation, literature search, drafting, and approval of the final version. MOA participated in data curation, literature search, drafting, and approval of the final version. AO was involved in conceptualization, data curation, literature search, drafting, and approval of the final version. OLL contributed to data curation, literature search, drafting, and approval of the final version. ORI conducted the literature search, critically appraised the manuscript, and approved the final version. BIO was involved in data curation, literature search, drafting, and approval of the final version.

Acknowledgements

We also acknowledge the members of staff involved in the management and care of the mother and baby.

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No competing interests reported.

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Rusty Pipe Syndrome: First Case Report from a Nigerian Lactating Mother

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Case presentation

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