A case report of primary necrotising fasciitis of the breast: A rare but deadly entity requiring rapid surgical management

Abstract

HighlightsPrimary necrotising fasciitis of the breast is an extremely rare entity.We present the youngest patient described in the literature.Prompt resuscitation and surgical intervention are critical to successful management.

Necrotizing fasciitis of breast in postpartum period: case report

“…Necrotizing fasciitis is a rare aggressive infection (0.4 cases in 100,000 individuals) 1 with high mortality rates (between 25 and 73%) 2 . It affects the subcutaneous and superficial fascia by necrosis, and most frequently affects the abdominal wall, perineum and extremities 2,3 . It may be primary or idiopathic when there is no evident reason such as skin tear, or secondary when the source of infection is known.…”

“…The secondary one is most frequent and can be precipitated by laceration, cut, abrasion, contusion, burn, bite, subcutaneous injection or surgical scar 2 . It is associated with immunodeficiency due to: alcoholism, chemotherapy, malignant neoplasms, use of corticoids, malnutrition, diabetes mellitus, polytrauma and peripartum period [1][2][3][4] . According to microbial etiology, it can be divided into three types.…”

“…Type II usually occurs in extremities, such as hemolytic streptococcal gangrene, and is caused by group A haemolytic Streptococcus. It may be associated with Staphylococcus aureus 1 , and Streptococcus pyogenes is the most common bacteria found in approximately one third of cases of necrotizing fasciitis 3 . Type III is associated with wounds made by fish or in contact with sea water 1 caused by Vibrio vulnificus.…”

“…Mortality can be reduced by up to 10% with early diagnosis and intensive support, adequate surgical debridement and broad spectrum antimicrobial therapy 2,3 . In early phase, it may be an empirical combination of a carbapenem or other β-lactam antibiotics with betalactamase and clindamycin and, in severe patients, a combination of vancomycin to cover methicillin-resistant Staphylococcus aureus.…”

“…Necrotizing fasciitis is an aggressive infection that affects the subcutaneous and superficial fascia by necrosis, and can be found more frequently in the abdominal wall, perineum and extremities [1][2][3] . Less than 20 cases were described in the breast and the literature points to breastfeeding and previous breast procedures as risk factors for this condition 1 .…”