Primary Necrotizing Fasciitis of the Breast in an Untreated Patient with Diabetes

Necrotizing fasciitis (NF) is a soft tissue infection that can be fatal. Diagnosis may be delayed because NF is easily misdiagnosed as an abscess or cellulitis [[1]]. It is commonly found in the extremities, perineum, and abdominal wall, but rarely in the breast. NF of the breast can be caused by previous surgery (e.g., mastectomy, implant augmentation) or trauma [[2]]. In this report, we present a rare case of primary NF of the breast in a patient with untreated diabetes.

A 31-year-old female patient presented to the emergency department with a 5-day history of skin color change, pain, and swelling in the left breast. The patient had been diagnosed with diabetes 6 years before, and had discontinued insulin treatment for the last 2 years. The patient reported no trauma and nor any previous surgical procedure on the breast, which was markedly swollen and erythematous. A patchy, purple and black eschar was observed in the medial area of the left breast ([Fig. 1]). Chest enhanced computed tomography revealed a fluid pocket approximately 9 cm in diameter with an air bubble in the left breast ([Fig. 2]). An emergency operation was performed to debride the necrotic skin and soft tissue. The disease was diagnosed as NF. After several debridements, the defected area was covered by a latissimus dorsi musculocutaneous flap and a full-thickness skin graft ([Fig. 3]). There were no complications, and the patient was discharged after two weeks.

Fig. 1 Initial photograph in the emergency department. A 31-year-old female patient presented to the emergency department with left breast skin color change, pain, swelling, and discharge.

Fig. 2 Initial chest ECT of the patient. There was an approximately 9-cm fluid pocket with an air bubble in the left breast, with edematous swelling and overlying skin thickening. ECT, enhanced computed tomography.

Fig. 3 Preoperative and postoperative photos of the patient. (A) After several debridements, extended defects remained through the skin and soft tissue in the left breast. (B) The defects were covered with a latissimus dorsi musculocutaneous flap and a full-thickness skin graft.

We experienced and report here a case in a young female patient of primary NF of the left breast that was successfully treated and reconstructed. To our knowledge, this is a rare case of a patient without previous trauma that spontaneously developed NF.

This article was presented as a poster at the 6th Research and Reconstructive Forum on April 4–8, 2016 in Daegu, Korea.

Publication History

Received: 31 March 2016

Accepted: 05 July 2016

Article published online:
20 April 2022

• References

• 1 Edlich RF, Cross CL, Dahlstrom JJ. et al. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med 2010; 39: 261-265
• 2 Yang B, Connolly S, Ball W. Necrotising fasciitis of the breast: a rare primary case with conservation of the nipple and literature review. JPRAS Open 2015; 6: 15-19