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一名年轻哺乳期女性患坏死性筋膜炎累及乳房的罕见表现:病例报告

Uncommon presentation of necrotizing fasciitis affecting the breast in a young breastfeeding patient: Case report.

作者信息

Benlghazi Abdelhamid, Benali Saad, Belouad Moad, Fakri Ahmed, El Mangoub Fatima, Kouach Jaouad

机构信息

Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Rabat, Morocco.

Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Rabat, Morocco.

出版信息

Int J Surg Case Rep. 2024 Jan;114:109147. doi: 10.1016/j.ijscr.2023.109147. Epub 2023 Dec 10.

Abstract

INTRODUCTION AND IMPORTANCE

Necrotizing fasciitis is a highly dangerous infection that poses a life-threatening risk as it rapidly spreads and causes tissue necrosis in the subcutaneous tissues and fascia. Although rare, the breasts can be affected by this infection, which adds to the complexity of the condition.

CASE PRESENTATION

A 26-year-old woman who had been breastfeeding for two months presented with pain, swelling, and fever in her left breast. The left breast showed skin darkening and foul-smelling discharge. The diagnosis was septic shock due to necrotizing fasciitis. Prompt treatment included surgical debridement, broad-spectrum antibiotics, and supportive care. The patient's condition remained challenging, and the infection was caused by multi-resistant bacteria.

CLINICAL DISCUSSION

Necrotizing fasciitis is a highly severe and aggressive type of soft tissue infection. It can range from minor or mild infections of the soft tissues to severe cases involving septic shock. While it is uncommon, necrotizing fasciitis can also affect the breasts. The diagnosis of breast NF relies on a combination of clinical evaluation, culture results, laboratory findings, and imaging studies. Swift surgical interventions, along with appropriate antibiotic therapy and supportive management, are vital for the patient's survival and improved prognosis.

CONCLUSIONS

Breast necrotizing fasciitis is frequently misdiagnosed due to the presence of thick breast tissue, which creates challenges in identifying the infection between the skin and deep fascia. Swift and extensive surgical debridement, combined with the administration of broad-spectrum antibiotics, are crucial components for effectively managing and preventing the significant morbidity and mortality associated with this condition.

摘要

引言与重要性

坏死性筋膜炎是一种极具危险性的感染,因其迅速扩散并导致皮下组织和筋膜的组织坏死,从而构成危及生命的风险。尽管罕见,但乳房也可能受到这种感染,这增加了病情的复杂性。

病例介绍

一名正在进行两个月母乳喂养的26岁女性,出现左侧乳房疼痛、肿胀和发热症状。左侧乳房皮肤变黑,有恶臭分泌物。诊断为坏死性筋膜炎所致的感染性休克。及时的治疗包括手术清创、广谱抗生素治疗和支持性护理。患者的病情仍然具有挑战性,感染是由多重耐药菌引起的。

临床讨论

坏死性筋膜炎是一种极其严重且侵袭性强的软组织感染类型。其范围可从轻微的软组织感染到涉及感染性休克的严重病例。虽然不常见,但坏死性筋膜炎也可影响乳房。乳房坏死性筋膜炎的诊断依赖于临床评估、培养结果、实验室检查结果和影像学检查的综合判断。迅速的手术干预,以及适当的抗生素治疗和支持性管理,对患者的生存和改善预后至关重要。

结论

由于乳房组织较厚,乳房坏死性筋膜炎常被误诊,这给识别皮肤与深筋膜之间的感染带来了挑战。迅速而广泛的手术清创,结合广谱抗生素的使用,是有效管理和预防与此病症相关的严重发病率和死亡率的关键组成部分。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b37/10800673/2fdfa6e66a3e/gr1.jpg

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