Necrotizing Fasciitis in a Lactating Breast: A Case Report and Literature Review

Abstract

Introduction: Necrotizing fasciitis (NF) is a serious, rapidly progressive disease with significant maternal morbidity and mortality. This case report highlights the rare occurrence of NF in a lactating breast. Patient concerns: A 3-week postnatal young patient exclusively breastfeeding developed left breast engorgement and pain and received two courses of antibiotics for left mastitis. At 6 weeks postnatal, she presented to the hospital with a left breast abscess and fever. Diagnosis: Inflammatory markers were raised. Ultrasound confirmed the presence of a breast abscess. Intervention: The patient was started on antibiotics, and ultrasound-guided aspiration was performed. However, the skin turned black with a rapidly spreading infection; subsequently, she had a debridement of necrotic breast tissue and a biopsy in the theater. Histology confirmed a diagnosis of NF. Outcome: A wound dressing with negative pressure wound therapy was applied. The patient was prescribed Cabergoline 0.25 mg every 12 hours for 2 days to stop milk production. She responded well to an autologous skin graft by the breast team and was discharged. Conclusion: The report emphasizes the importance of considering NF as a potential diagnosis in cases of infection in a lactating breast unresponsive to conventional treatment. Early diagnosis and prompt treatment with antibiotics, surgical debridement, and multidisciplinary care are prudent to prevent adverse sequelae, such as sepsis, partial/total mastectomy, and psychological distress. A biopsy is mandatory to exclude coexistent malignancy.