Breast abscess in a competitive high school swimmer: a case of toxic shock syndrome

Management of life-threatening staphylococcal septic shock in a breastfeeding woman with breast abscess: A case report

Introduction and importance

Breast abscess is a common problem in breastfeeding women. However, septic shock secondary to methicillin resistant Staphylococcus aureus (MRSA) from breast abscess is very rare. Successful management of this condition in our center may provide experience of treatment for similar patients.

Case presentation

A 20-year-old breastfeeding woman with breast abscess was transferred to our center. General condition of the patient deteriorated rapidly to life-threatening septic shock. Culture of pus later demonstrated MRSA infection, with vancomycin susceptibility. Several measures were emergently implemented, including removal of necrotic tissue, continuous catheter irrigation and drainage, intravenous infusion of vancomycin, pumping norepinephrine, fluid resuscitation and transfusion of plasma. The patient was cured and discharged after 10 day's treatment.

Clinical discussion

Life-threatening septic shock secondary to MRSA in breastfeeding women with breast abscess is very rare. Nevertheless, clinicians should remain vigilant to early symptoms and signs of septic shock. Catheter irrigation and drainage, vancomycin and fluid resuscitation are essential for septic shock in lactational breast abscess.

Conclusions

We highlight the importance of the diagnosis and management of life-threatening septic shock secondary to MRSA in breast abscess to help us further understand this rare and fatal disease.

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Life-threatening septic shock secondary to MRSA in a breastfeeding woman with breast abscess is very rare.

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We should pay more attention to the early symptoms and signs of septic shock.

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Catheter irrigation and drainage, vancomycin and fluid resuscitation are essential for septic shock in breast abscess.

Staphylococcal toxic shock syndrome in a lactating mother with breast abscess: A case report

Introduction

The highest risk for Staphylococcal Toxic Shock Syndrome are female patients with pre-existing Staphylococcal vaginal colonization who frequently use contraceptive sponges, diaphragms or tampons. In addition patients with burns, soft tissue injures, retained nasal packing, post-abortion, post-surgical, post intrauterine device placement and abscess formation are also at high risk.

Case presentation

A 19 years old female complaint of high fever with altered level of consciousness. She also had history of nausea, vomiting, diarrhea and pain on her left breast for 5 days. She developed desquamation on her palms and soles on the day three of her admission to ICU. Ultrasonography of her left breast showed 2*2*1 cm abscess collection and the culture report from breast abscess showed Staphylococcus aureus, sensitive to clindamycin, vancomycin and resistant to methicillin. She showed clinical improvement after commencing vancomycin and clindamycin as per culture sensitivity report of breast abscess.

Discussion

Toxic shock syndrome secondary to breast abscess in adult is infrequently reported. The diagnosis of Toxic shock syndrome is made by the Centers for Disease Control and Prevention (CDC) definition. Antibiotics for treatment of this condition should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) in combination with either clindamycin or linezolid.

Conclusion

Treatment for breast abscess warrants incision and drainage as important as antibiotics with anti-toxin. Focused history, physical examination, and laboratory investigations are crucial for the diagnosis and management of this condition.

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The average annual incidence of TSS among adults is low and MRSA isolation among those cases is even more rare.

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TSS secondary to breast abscess in adult is infrequently reported.

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Treatment for breast abscess warrants I &D as important as antibiotics with anti-toxin.

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TSS is a potentially deadly condition and it requires prompt recognition and management.