Necrotizing Fasciitis of the Breast: A Review of the Literature

[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.

Necrotizing Fasciitis of the Breast: A Case Series and Review of the Literature

Abstract Background: Primary necrotizing fasciitis of the breast is a rare clinical condition and therefore a challenge for the clinical doctor. Its severity is associated with high morbidity and mortality. Patients and Methods: In the current article we present three cases that we treated in our surgical department with a combination of empirical antibiotic treatment, complete surgical debridement in stages, and negative pressure wound therapy. Conclusions: It appears that prompt diagnosis and surgical intervention are key for the successful management of these cases. The recognition of early clinical signs as well as risk factors are issues of great importance. A high index of suspicion is required for the early diagnosis and treatment, aiming to the best outcome for the patient.

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

BACKGROUND

Necrotizing fasciitis is a life-threatening and potentially fatal condition which commonly affects extremities, abdominal wall and perineum. However, it can affect any body part. Breasts are very rarely affected, with most of the cases are following surgical intervention or trauma. Predisposing conditions include diabetes, chronic alcoholism, advanced age, vascular disease, and immunosuppression and many cases are preceded by an injury or invasive procedure. Here we present necrotizing fasciitis of the breast in a 28-year-old female patient with no identified risk factor.

CLINICAL PRESENTATION

A 28-year-old woman on her 4th month of lactation presented to the emergency department with a 4-day history of right breast pain and swelling. Associated with this, she had darkening of the skin of the right breast, high-grade fever, and foul-smelling discharge from the wound. On examination, she was febrile, tachycardic and hypotensive. Breast examination showed signs suggestive of NF. Subsequently, the patient was managed with broad spectrum antibiotics, supportive care, surgical debridement followed by partial mastectomy and finally the patient was discharged improved.

CONCLUSION

Although it is a rare phenomenon, necrotizing soft-tissue infections of the breast can progress rapidly and carry a high mortality rate. Therefore, early diagnosis and immediate surgical intervention are of paramount importance. Here, we aim to show the importance of early diagnosis and the need for appropriate therapy to avoid complications and death.

Breast rescue after necrotizing fasciitis

Necrotizing fasciitis is a dangerous and rapidly spreading infection of soft tissue involving skin, subcutaneous tissue and fascia; muscles can be concerned but often omitted. It's considered as emergency due to its fulminant nature. The necrotizing fasciitis of the breast is exceptional. Management is based on surgical debridement and, in the case of breast, mastectomy in most cases is inevitable. We describe a case-report of breast necrotizing fasciitis with prompt management and with satisfactory cosmetic result owing to dermal autograft.

Necrotizing Infection of the Breast: A Case Report on a Rare Presentation of Breast Carcinoma

Necrotizing infection (NI) of the breast associated with underlying malignancy is a rare phenomenon characterized by necrosis of breast parenchyma, causing a delay in diagnosis and even leading to sepsis. We present a case of a 42-year-old female with NI of the right breast while on homeopathic treatment for a right breast lump for six months. Tissue culture showed a polymicrobial infection and histopathology established the diagnosis of breast carcinoma. After treating the NI, her breast cancer was managed as per standard guidelines.

Necrotizing fasciitis of the chest wall: A clinical case report and literature review

Necrotizing fasciitis of the chest wall is a very rare pathology, but with significant mortality, representing a therapeutic challenge. All international reports indicate the need for early diagnosis and an aggressive medical-surgical attitude in order to improve the prognosis. In addition to a review of literature, we present a case developed secondary to a thoracic pleural drainage for pyopneumothorax associated with significant bronchopleural fistula in a destroyed tuberculous left lung. Along with medical treatment, extensive surgical debridement was required. Despite drainage incisions and negative pressure wound therapy (NPWT), the evolution of the fasciitis was difficult, due to bronchopleurocutaneous fistula. Thus, the Azorin procedure (transcervical mediastinoscopic closure of the left main bronchus) was performed. Once this procedure was completed, the inflammatory phenomena were controlled which allowed for a second step consisting of left pneumonectomy, with the application of specific methods for the prevention of bronchial fistula. The clinical case was a therapeutic challenge requiring a complex, staged, multidisciplinary approach due to both the immunocompromised terrain and the severity of the lesions. In conclusion, early recognition and aggressive and combined application of medical and surgical treatment methods can ensure therapeutic success.

Empyema necessitans - An unusual cause of necrotising fasciitis of the breast

Necrotising fasciitis is a dreaded aggressive soft tissue infection that can cause extensive tissue necrosis. It may arise in the breast where its diagnosis may not readily be evoked.

Necrotizing Fasciitis of the Breast Requiring a Life-Saving Mastectomy: A Case Report and Literature Review

Necrotizing soft tissue infection of the breast is an extremely rare event in routine surgical practice. It is the most aggressive form of soft tissue infection and a real surgical emergency. It is associated with a high risk of mortality if not diagnosed promptly. A Literature search has revealed only a few such cases. The exact etiology is variable and very often multifactorial. Early recognition and prompt surgical treatment along with broad-spectrum antibiotic therapy are of paramount importance to prevent mortality. In this report, we present the first case of necrotizing fasciitis of the breast following an insect bite in the literature, in a 57-year-old diabetic patient with a delayed presentation that required a life-saving mastectomy.

Monomicrobial Necrotizing Fasciitis of the Breast: A Case Managed by Partial Mastectomy and Hydrogel Dressing

Necrotizing fasciitis (NF) is a rare life-threatening bacterial infection, which can be monomicrobial or polymicrobial, involving the fascia and eventually leading to necrosis. The course of the disease is rapidly progressive and can be misdiagnosed as an abscess or cellulitis. The disease requires more attention with respect to early diagnosis and treatment as it has a high mortality rate. In this report, we present the case of a 60-year-old female, who was a known case of hypertension and type 2 diabetes mellitus (T2DM). The patient presented to the emergency department on the 21st of October 2020, complaining of left breast pain for 10 days, which was associated with fever and nausea. On physical examination, the left breast was swollen and tender to palpation. There was a single patch of inflamed skin measuring 1 x 1 cm with greenish discoloration in the inframammary fold. Ultrasound of the breast showed a patch of focal mastitis with edema seen at 4-8 o’clock with no underlying fluid collection. She was admitted as a case of left breast abscess and was started on antibiotics. Despite the antibiotic therapy, the patient was still febrile and developed two more inflammatory and necrotic patches with no discharge. The patient underwent urgent surgical debridement of the necrotic tissues, leaving the wound packed for postoperative dressing. The patient stayed in isolation for a total of 25 days as she was found to be positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The surgical wound was closed, and the patient was discharged. Early diagnosis and management of NF is the key to saving the patient's life and improving outcomes.