Primary necrotizing fasciitis of the breast in a young patient, a case report

Necrotizing fasciitis of the breast with extension to the chest wall myofascial layer in a lactating mother: a rare case report

INTRODUCTION AND IMPORTANCE

Necrotizing fasciitis is one of the deadliest forms of infection to affect human kind. It usually happens in the presence of risk factors and often involves the trunk, the limbs and the perineum. Primary breast involvement is quite rare. Early diagnosis and management is of paramount importance to decrease morbidity and death.

CLINICAL PRESENTATION

A 35 years old female patient presented to our facility with progressive left breast swelling and pain of 05 days. She also had discoloration of skin, anorexia and high grade fever. She was lactating mother to a 1 year old baby. She was clinically diagnosed with necrotizing mastitis with chest wall extension and underwent total mastectomy and chest wall debridement. Chest wall wound defect is managed by doing split thickness skin graft. The biopsy result confirmed the diagnosis of necrotizing mastitis.

DISCUSSION

Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. It can affect any area of the body. Breast is, however, rarely affected. In the breast it typically occurs after trauma to it in the form of surgery or biopsy. The diagnosis of necrotizing mastitis can be delayed because of its rarity and atypical presentation.

CONCLUSION

Necrotizing fasciitis of the breast is very uncommon; hence diagnosing it requires a high index of suspicion. Once diagnosis is made the cornerstones of treatment include aggressive surgical debridement, initial broad spectrum antibiotics, and supportive care. Post-debridement wound reconstruction should be individualized.

Necrotizing fasciitis of the breast in a breastfeeding mother: A case report

INTRODUCTION

Necrotizing fasciitis (NF) is a rapidly progressive life-threatening infection involving necrosis of subcutaneous tissues and fascia. Though it mainly affects the extremities, perineum and abdominal wall, it rarely affects the breast.

PRESENTATION OF CASE

A 30-year-old woman on postpartum day seven presented with one-day history of fever with chills and rigors and painful, swollen and tender left breast. Although the initial diagnosis was mastitis, the disease progressively worsened with the breast developing ischaemic necrotic areas in the lower quadrants and nipple areolar region. Therefore, a clinical diagnosis of breast necrotizing fasciitis was made. She was managed with broad-spectrum antibiotics, hypertonic saline dressings and supportive care and debridement. Cultures from wound swabs showed multi-resistant polymicrobial growth.

DISCUSSION

Necrotizing fasciitis of the breast is mainly reported following pregnancy like in our patient. The diagnosis is mainly clinical with the help of laboratory and radiological investigations. Broad spectrum IV antibiotics, surgical/chemical debridement, VAC dressings and supportive care are the main principles of managing necrotizing fasciitis. Alongside this, psychological support was crucial in the management of our patient.

CONCLUSION

We have reported rare presentation of a breastfeeding mother presenting with NF. We were able to successfully manage due to early identification and appropriate management.

[Post-mastectomy necrotizing fasciitis and immediate prosthetic breast reconstruction: First case report]

Necrotizing fasciitis is a rapidly progressive soft tissue infection extending from the skin to the fascia, resulting in extensive necrosis. It is a very rare but serious complication, with mortality ranging from 10 to 15%. Optimal management involves early diagnosis followed by treatment combining antibiotic therapy and wide surgical removal as soon as possible. Localisation in the breast is uncommon. Although most cases are primary necrotizing fasciitis of the breast, several cases of necrotizing fasciitis have been reported in the post-operative aftermath of breast surgery. We present a case of necrotizing fasciitis of the breast following submammary mastectomy with immediate reconstruction using a pre-pectoral silicone implant, which resulted in multiple organ failure and the death of the patient despite optimal medical and surgical management. This is the first case to occur after immediate breast reconstruction.

Uncommon presentation of necrotizing fasciitis affecting the breast in a young breastfeeding patient: Case report

INTRODUCTION AND IMPORTANCE

Necrotizing fasciitis is a highly dangerous infection that poses a life-threatening risk as it rapidly spreads and causes tissue necrosis in the subcutaneous tissues and fascia. Although rare, the breasts can be affected by this infection, which adds to the complexity of the condition.

CASE PRESENTATION

A 26-year-old woman who had been breastfeeding for two months presented with pain, swelling, and fever in her left breast. The left breast showed skin darkening and foul-smelling discharge. The diagnosis was septic shock due to necrotizing fasciitis. Prompt treatment included surgical debridement, broad-spectrum antibiotics, and supportive care. The patient's condition remained challenging, and the infection was caused by multi-resistant bacteria.

CLINICAL DISCUSSION

Necrotizing fasciitis is a highly severe and aggressive type of soft tissue infection. It can range from minor or mild infections of the soft tissues to severe cases involving septic shock. While it is uncommon, necrotizing fasciitis can also affect the breasts. The diagnosis of breast NF relies on a combination of clinical evaluation, culture results, laboratory findings, and imaging studies. Swift surgical interventions, along with appropriate antibiotic therapy and supportive management, are vital for the patient's survival and improved prognosis.

CONCLUSIONS

Breast necrotizing fasciitis is frequently misdiagnosed due to the presence of thick breast tissue, which creates challenges in identifying the infection between the skin and deep fascia. Swift and extensive surgical debridement, combined with the administration of broad-spectrum antibiotics, are crucial components for effectively managing and preventing the significant morbidity and mortality associated with this condition.