2023-04-24 13:33:32
A 25-year-old woman was taken to the emergency room by ambulance over the weekend. She suffers from nausea, vomiting, diarrhea and weakness. There is also pain in the left breast [1].
Physical and instrumental examinations
The left breast is red and shows scratch marks. There is no clinical or sonographic evidence of an abscess. The patient is admitted as an inpatient. Because of the suspected mastitis, she is given flucloxacillin (intravenously).
Her laboratory values on admission: Leukocytes 7.68/nl, CRP 8.2mg/dl, creatinine at 1.36mg/dl and PCT 24.52ng/ml. Other laboratory parameters and blood cultures are unremarkable.
As the day progressed, the patient’s general condition deteriorated. The next morning, doctors note whitish necrotizing erosion on the left breast with peripheral hemorrhage and surrounding erythema, and warmth. Sonographically they still find no evidence of an abscess. A CT scan of the thorax/abdomen also remained unremarkable.
A new laboratory diagnosis shows a significant increase in the inflammatory parameters (leukocytes 12.45/nl, CRP 26.9 mg/dl, PCT 56.94 ng/ml and S-creatinine 2.91 mg/dl).
The attending physicians then supplement the antibiotic therapy with piperacillin/tazobactam and clindamycin. In the followingnoon around 4 p.m. they indicated the administration of penicillin G and immediate radical mastectomy. Swabs taken intraoperatively contain gram-positive cocci, namely Streptococcus pyogenes.
Infection levels decrease sharply within hours postoperatively. After a hospital stay of regarding more than 2 weeks, the young woman can finally leave the hospital “if she feels well and continues to take oral antibiotics with clindamycin”. A check following 6 months shows a scar that has healed without irritation.
discussion
The authors recall that streptococcal toxic shock syndrome (STSS) is a potentially life-threatening complication. The three-phase process is typical:
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First, there is a prodromal phase lasting regarding 24 to 48 hours with hypotensive blood pressure values, flu-like, but also gastrointestinal symptoms. Skin lesions might sometimes already be visible. Neurological symptoms, including delirium, also occur in some patients.
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Systemic symptoms such as tachycardia, high fever and shortness of breath are typical of the second phase.
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The 3rd phase initiates multi-organ failure and ends fatally without aggressive therapy.
As Schoffer and colleagues emphasize, the most important therapy is the immediate and generous surgical excision of the focus of infection. The decisive factor here is the early detection of the present infection.
The article originally appeared on Univadis.de.
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#young #woman #mastitis #lifethreatening
