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. 2019:65:10-14.
doi: 10.1016/j.ijscr.2019.10.020. Epub 2019 Oct 18.

Necrotising fasciitis of the breast: A rare but deadly disease

Bertram Marks  1 , Tarannum Fasih  2 , Sunil Amonkar  2 , Mujahid Pervaz  2
Affiliations

Necrotising fasciitis of the breast: A rare but deadly disease

Bertram Marks et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Necrotising fasciitis is a rare but deadly bacterial infection causing soft tissue and fascial necrosis. It is associated with a mortality rate of 25%. It is characterised by; erythematous skin, which turns dusky blue before haemorrhagic bullae develop; localised pain; and inflammation. It is most commonly found in the extremities, the abdomen or the perineum but is rarely seen in the breast.

Case presentation: We describe a 54-year-old lady who presented with breast erythema and raised inflammatory markers. Initially treated as cellulitis, however when her symptoms did not improve and despite IV antibiotics her bloods worsened, a CT scan was performed which showed a large volume of interstitial soft tissue gas with diffuse fat stranding, consistent with necrotising fasciitis. Debridement of her breast alongside the use of sensitive antibiotics and ITU support led to a satisfactory outcome.

Discussion: We discuss how an early diagnosis can be made by the recognition of a triad of symptoms common in necrotising fasciitis, and how optimal management can be achieved with the incorporation of imaging to successfully identify the condition and allow targeted debridement of the areas of necrotising fasciitis.

Conclusion: A high index of suspicion should be held if pain is disproportionate to the signs or sepsis is present. To aid an early diagnosis, imaging of the breast should be performed early to avoid delay in treatment.

Keywords: Breast; Case report; Cross-sectional imaging; Necrotising fasciitis.

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Conflict of interest statement

No conflicts of interest.

Figures

Fig. 1
Fig. 1
CT imaging of right breast demonstrating extensive soft tissue gas.
Fig. 2
Fig. 2
Post-operative picture after first re-look operation (left). Three months after surgery (right).
Fig. 3
Fig. 3
Clinical diagnostic triad for NFB: *where pain is disproportionate to signs; **also includes a swollen or oedematous breast.
Fig. 4
Fig. 4
Management triad for NFB: *with IV fluids and broad spectrum antibiotics; **Imaging: CT/MRI; ***Surgery: Extensive debridement.
See this image and copyright information in PMC

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