title: Breast ecchymosis: Unusual complication of an antidepressant agent.
abstract: BACKGROUND
  Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that is safely used for treatment of psychosomatic disorders. Despite being associated with a low side effect profile, it has been reported to cause hematological side effects including vaginal bleeding, epistaxis, purpura, hematuria, intracranial bleeding, and rectal bleeding. Isolated breast ecchymosis is one of exceedingly rare SSRI-induced hematological abnormalities.
  
  
  METHODS
  In this case study, we report a case of left breast ecchymosis in a 75-year-old woman that developed in conjunction with use of the SSRI fluoxetine.
  
  
  CONCLUSIONS
  The use of SSRIs has surged over the past decades due to increased diagnosis and focus on clinical management of depression and anxiety disorders, especially in developed nations. The low side effect profiles of the eight currently marketed SSRI agents has further promoted their use in the general population. While the most commonly reported side effects are mild and relatively tolerable, a risk of SSRI-related abnormal bleeding exists and may represent a life-threatening side effect. The most frequent SSRI-related bleeding manifestation is ecchymosis, but cases of isolated breast ecchymosis are exceedingly rare and to date only one report of SSRI-induced breast ecchymosis is included in the publicly available literature.
  
  
  CONCLUSIONS
  Three factors may have played a role in lack of reports describing SSRI-induced breast ecchymosis in literature. First, SSRIs indeed very seldom cause breast ecchymosis; second, physicians are not aware of such a causal relationship; and third, physicians find this side effect not worth to publish.
authors.affiliation: Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey. Electronic address: akbulutsami@gmail.com.
authors.forename: Sami
authors.initials: S
authors.lastname: Akbulut
authors.affiliation: Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yagmur
authors.affiliation: Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Gumus
authors.affiliation: Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Babur
keywords: Breast; Ecchymosis; Fluoxetine