Yu Jiangting, Chen Jiaying, Huang Tianjian, Gu Xidong
Department of Breast Surgery, The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China.
Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, People's Republic of China.
Int Med Case Rep J. 2025 Jul 4;18:791-809. doi: 10.2147/IMCRJ.S512859. eCollection 2025.
Breast abscess, the most severe complication of mastitis, occurs when an infection spreads through the nipple into the breast tissue, contaminating the milk ducts and forming a purulent cavity. Nonetheless, this condition is less common in pregnant women. is the predominant causative agent in lactating women; however, -associated breast abscesses during pregnancy remain clinically rare, with limited documented cases.
A 26-year-old Chinese woman with G1P0 singleton at 33 weeks of pregnancy presented with right breast pain and lumps without obvious triggers, accompanied by enlarged right axillary lymph nodes and a large amount of pus with a peculiar odor in the right breast. After breast ultrasonography, cytological puncture smear, pus culture, and metagenomic next-generation sequencing, the patient was confirmed to have gestational mastitis with infection. Given that the patient had a high-risk pregnancy, the use of antibiotics sensitive to , such as metronidazole, might affect the intrauterine fetus, and infection with this bacterium could increase the risk of placental abruption and intrauterine fetal distress. Based on the obstetrician's and pediatrician's recommendations, the patient opted for a cesarean section at 37 weeks to facilitate the delivery of a healthy neonate weighing 3110 g (Apgar scores of 10 at 1 min and 5 min) in the left anterior sacral position and was advised to opt for lactation-suppressing medication and postpartum antibiotics.
This case highlights the importance of close monitoring of pus characteristics (eg, color, odor, and volume) in pregnancy-associated breast abscesses to expedite the diagnosis of infectious mastitis and pathogen identification. Treatment with small incision drainage and targeted antibiotics during pregnancy significantly improved the outcomes. Postpartum breast milk return and combined antibiotic therapy further contributed to the resolution of inflammation.
乳腺脓肿是乳腺炎最严重的并发症，当感染通过乳头扩散到乳腺组织，污染乳管并形成脓性腔隙时就会发生。尽管如此，这种情况在孕妇中较少见。 是哺乳期女性的主要病原体；然而，孕期与 相关的乳腺脓肿在临床上仍然罕见，文献记载的病例有限。
一名26岁的中国女性，孕1产0，单胎妊娠33周，出现右乳疼痛和肿块，无明显诱因，伴有右腋窝淋巴结肿大，右乳有大量伴有特殊气味的脓液。经过乳腺超声、细胞学穿刺涂片、脓液培养和宏基因组下一代测序，确诊该患者患有 感染的妊娠期乳腺炎。鉴于该患者为高危妊娠，使用对 敏感的抗生素（如甲硝唑）可能会影响宫内胎儿，且这种细菌感染会增加胎盘早剥和宫内胎儿窘迫的风险。根据产科医生和儿科医生 的建议患者选择在37周时进行剖宫产，顺利分娩出一名体重3110g的健康新生儿（1分钟和5分钟时阿氏评分均为10分），新生儿为左前骶位，并建议患者选择回奶药物和产后抗生素。
本病例强调了密切监测妊娠相关乳腺脓肿脓液特征（如颜色、气味和量）对于快速诊断感染性乳腺炎及鉴定病原体的重要性；孕期采用小切口引流和针对性抗生素治疗可显著改善治疗效果；产后回奶及联合抗生素治疗进一步促进了炎症的消退。
