Monomicrobial Necrotizing Fasciitis of the Breast: A Case Managed by Partial Mastectomy and Hydrogel Dressing

Mersil, Mohammed; Marzouk, Mohammed; Labeeb, Hamad

Necrotizing fasciitis (NF) is a rare life-threatening bacterial infection, which can be monomicrobial or polymicrobial, involving the fascia and eventually leading to necrosis. The course of the disease is rapidly progressive and can be misdiagnosed as an abscess or cellulitis. The disease requires more attention with respect to early diagnosis and treatment as it has a high mortality rate. In this report, we present the case of a 60-year-old female, who was a known case of hypertension and type 2 diabetes mellitus (T2DM). The patient presented to the emergency department on the 21st of October 2020, complaining of left breast pain for 10 days, which was associated with fever and nausea. On physical examination, the left breast was swollen and tender to palpation. There was a single patch of inflamed skin measuring 1 x 1 cm with greenish discoloration in the inframammary fold. Ultrasound of the breast showed a patch of focal mastitis with edema seen at 4-8 o’clock with no underlying fluid collection. She was admitted as a case of left breast abscess and was started on antibiotics. Despite the antibiotic therapy, the patient was still febrile and developed two more inflammatory and necrotic patches with no discharge. The patient underwent urgent surgical debridement of the necrotic tissues, leaving the wound packed for postoperative dressing. The patient stayed in isolation for a total of 25 days as she was found to be positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The surgical wound was closed, and the patient was discharged. Early diagnosis and management of NF is the key to saving the patient's life and improving outcomes.