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

Abstract

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 57year-old diabetic patient with a delayed presentation that required a life-saving mastectomy.

A near-miss diagnosis of necrotizing breast fasciitis complicated by atrial fibrillation secondary to septic focus: a case report and brief review of literature

“…Staged debridements as opposed to immediate mastectomy has become the new standard of practice, however, in most cases of primary NF of the breast, mastectomy is required to achieve adequate source control. 17 The antibiotic regimen for NF of the breast is broad but usually is narrowed based on the organisms isolated from wound cultures. The infection can be further classified based on the organisms found: Type 1 is considered polymicrobial and can be composed of Gram-positive, Gram-negative, and anaerobes, whereas Type 2 is usually with Group A Streptococcus or other beta-hemolytic Streptococci in combination with other infectious pathogens.…”

Necrotizing Soft Tissue Infections of the Breast: A Potentially Lethal Surgical Emergency

“…Case Reports in Surgery Early debridement and antibiotic coverage significantly the morbidity and mortality associated with NSTIs. In cases involving the though, reports supported mastectomy as the most commonly performed procedure (52% of cases in two systematic reviews) [3].…”

“…These infections typically involve the perineum, lower limbs, and torso, involving extensive soft tissue destruction along with systemic signs of sepsis. They are often associated with significant mortality and morbidity, particularly because of diagnostic and treatment delays [ 2 , 3 ].…”

Necrotising cellulitis of the breast associated with a fungating mucinous adenocarcinoma

“…As with other NSTIs, they are usually seen in poorly controlled diabetics or immunocompromised patients, though they have been reported in healthy individuals as well 2. NSTIs are most commonly idiopathic or the sequelae of an open wound 2. Here, we present a unique case of a fungating mucinous adenocarcinoma associated with an NSTI due to untreated diabetes mellitus.…”

“…Frequently misdiagnosed as cellulitis, mastitis, abscess or inflammatory breast cancer, patients with an NSTI consequently often require emergent mastectomy 1. As with other NSTIs, they are usually seen in poorly controlled diabetics or immunocompromised patients, though they have been reported in healthy individuals as well 2. NSTIs are most commonly idiopathic or the sequelae of an open wound 2.…”