Sandaruwan Umayanga, Lakmal Kasun, Dissanayake Hasthaka, Wijekoon Sepalika, Wijesinghe Kanchana, Pathirana Aloka
Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.
University Surgical Unit, Colombo South Teaching Hospital, Sri Lanka.
Int J Surg Case Rep. 2025 Feb;127:110831. doi: 10.1016/j.ijscr.2025.110831. Epub 2025 Jan 3.
Necrotizing fasciitis (NF) is a rapidly progressive life-threatening infection involving necrosis of subcutaneous tissues and fascia. Though it mainly affects the extremities, perineum and abdominal wall, it rarely affects the breast.
A 30-year-old woman on postpartum day seven presented with one-day history of fever with chills and rigors and painful, swollen and tender left breast. Although the initial diagnosis was mastitis, the disease progressively worsened with the breast developing ischaemic necrotic areas in the lower quadrants and nipple areolar region. Therefore, a clinical diagnosis of breast necrotizing fasciitis was made. She was managed with broad-spectrum antibiotics, hypertonic saline dressings and supportive care and debridement. Cultures from wound swabs showed multi-resistant polymicrobial growth.
Necrotizing fasciitis of the breast is mainly reported following pregnancy like in our patient. The diagnosis is mainly clinical with the help of laboratory and radiological investigations. Broad spectrum IV antibiotics, surgical/chemical debridement, VAC dressings and supportive care are the main principles of managing necrotizing fasciitis. Alongside this, psychological support was crucial in the management of our patient.
We have reported rare presentation of a breastfeeding mother presenting with NF. We were able to successfully manage due to early identification and appropriate management.
坏死性筋膜炎（NF）是一种迅速进展的危及生命的感染，涉及皮下组织和筋膜坏死。虽然它主要影响四肢、会阴和腹壁，但很少影响乳房。
一名30岁女性，产后第7天，出现发热伴寒战和高热1天，左侧乳房疼痛、肿胀且触痛。尽管最初诊断为乳腺炎，但病情逐渐恶化，乳房下象限和乳头乳晕区域出现缺血坏死区。因此，临床诊断为乳房坏死性筋膜炎。对她进行了广谱抗生素治疗、高渗盐水敷料处理、支持治疗和清创术。伤口拭子培养显示有多重耐药的多种微生物生长。
乳房坏死性筋膜炎主要在妊娠后发生，如我们的患者。诊断主要依靠临床，辅以实验室和影像学检查。广谱静脉抗生素、手术/化学清创、负压伤口治疗（VAC）敷料和支持治疗是治疗坏死性筋膜炎的主要原则。除此之外，心理支持对我们患者的治疗至关重要。
我们报告了一例罕见的母乳喂养母亲患坏死性筋膜炎的病例。由于早期识别和适当治疗，我们成功地进行了处理。
