Mastitis Case Report: Diagnosis, Symptoms & Treatment

A Case Report On Mastitis

J. Sheetal

Nursing supervisor, Kauvery Hospital, Tirunelveli, Tamil Nadu

Abstract

Mastitis is a breast infection, often occurs during breastfeeding that can lead to the formation of breast abscess, a painful pus-filled lump. While mastitis is more common, breast abscesses are a serious complication requiring prompt treatment, often involving aspiration or incision and drainage procedures, along with antibiotics. Early intervention and proper management of mastitis are crucial to prevent abscess formation and ensure successful outcomes for both mastitis and breast abscesses.

Introduction

Mastitis is an inflammatory condition in the breast that may be accompanied by infection. Breast inflammation during breastfeeding requires immediate and appropriate treatment. Without proper treatment, inflammation may cause the premature cessation of breastfeeding, which is considered the normative standard for infant feeding and nutrition.

Based on the nutritional and immunological value of breast milk, the recommendations by the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) is exclusive breastfeeding up to 6 months of age. After 6 months, continue breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.

Recent meta-analyses indicate breastfeeding protects against childhood infections, allows for a possible increase in intelligence, and for a reduction in overweight and diabetes.

For nursing women, breastfeeding gives protection against breast cancer, and it also protect against ovarian cancer and type 2 diabetes. Improperly treated inflammation can develop into a breast abscess. Therefore, choosing the right treatment and providing information and therapeutic guidelines to the patient is of great importance.

Breast Inflammation may be due to several different etiologies, infectious or not, but most breast inflammation is expressed as hard, swollen, and red breast area, accompanied by a fever above 38.5 °C, chills, and a bad general flu-like feeling. Many times, there is a continuum, namely: stasis of breast milk develops into an inflammation without infection, which develops into infectious mastitis that may later develop into an abscess.

Pathophysiology

Supportive Treatment

Effective Milk Removal: In cases of milk stasis at a deeper location in the breast tissue, the most important management step is frequent and effective milk removal. Mothers should be encouraged to breastfeed more frequently, starting on the affected breast. After feeding, expressing milk by hand or pump may contribute to good breast emptying, and thus contribute to healing; massage of the painful area toward the nipple helps to drain the breast properly.

In recent years, awareness of the importance of lymphatic massage in the treatment of mastitis has risen. To promote fluid drainage toward the axillary lymph nodes, the mother should massage the skin surface from the areola to the axilla.

There is no evidence of risk to the healthy, term infant for continuing breastfeeding from a mother with mastitis. Women who are unable to continue breastfeeding should express the milk from breast by hand or pump, as the sudden cessation of breastfeeding leads to a risk of abscess development.

Sometimes infants refuse to breastfeed

Due to decreased milk production in the inflamed breast, a characteristic of mastitis, or due to a change in milk taste. Mastitis affects the biochemical composition of the milk, and as a result, the milk becomes saltier. A woman who is unable to breastfeed the inflamed breast due to the baby’s refusal or for any other reason should pump or hand express the milk, as a sudden cessation of milk removal can cause the development of an abscess.
A hot compress or hot shower immediately before breastfeeding or suction can facilitate the release of milk from the breast.
Cold compresses after breastfeeding or pumping and between breastfeeding will reduce any possible pain or edema.

In addition to effective milk removal,

Rest,
Nutrition,
Drinking enough fluids

are essential steps that can help the healing process.

Management

First, it is important to emphasize that supportive therapy should be continued concurrently with drug treatment. Medication alone is not enough.
Analgesics: Pain interferes with the milk ejection reflex, and therefore the mother should be encouraged to take analgesics. As ibuprofen has anti-inflammatory properties in addition to analgesia, it has an advantage over paracetamol. Ibuprofen at doses of up to 1.6 gm per day is considered safe for breastfeeding.
Antibiotics: If symptoms do not improve within 12–24 hr of starting treatment, antibiotic therapy should be started.
Traditional incision and drainage (I&D) versus ultrasound (USG)-guided aspiration in breast abscess management.

The authors here present you a case of a young female who had breast abscess and complications and was managed under them, with review of the management of breast abscess.

Outcome

These results highlight that USG-guided aspiration offers a minimally invasive and effective method for managing breast abscesses, leading to quicker recovery, better cosmetic outcomes, and higher patient satisfaction compared to the traditional I&D approach. Early diagnosis and intervention with USG-guided aspiration can prevent complications and reduce the need for open surgery. Based on these findings, USG-guided aspiration is a safer and more efficient method for treating breast abscesses, particularly when initiated promptly after diagnosis.

Case Presentation

A 31-yr female, post-natal mother/P1L1/LSCS/POD-41, now presented with complaints of left breast swelling and pain, fever, and rashes over upper body for 3 days. She was initially evaluated at outside hospital, where breast sonogram taken showed left mastitis, left axillary lymphadenopathy and abscess formation, BIRADS- 2 )Benign) .Patient hemodynamically unstable. Inotropes were started and referred here for further evaluation and management.

On Examination:

Vital Signs

PR-120/min

RR- 36/min

BP- 80/50 mmhg

Spo2-93% on room air

Temp- 100.8 Celsius

Local Examination:

Swelling (+), tenderness (+) in left abscess, rashes(+) over trunk and neck region.

Base Line Examination:

HB- 10.1g/dl

Leucocytosis (16160)

Elevated procalcitonin (7.96)

CPR was more than150

Urea/creatinine- 34.3

Chest X RAY

Shows ARDS

Ultra Sonogram

Depicts: An abscess is been seen as a hypoechoic lesion

Signs And Symptoms of Breast Infection

Mastitis:

Flu-like symptoms, malaise, and myalgia
Fever
Breast pain
Decreased milk outflow
Breast warmth
Breast tenderness
Breast firmness
Breast swelling
Breast erythema
Enlargement of axillary lymph nodes

Breast abscess (in addition to the above):

Well-circumscribed fluctuant mass in the affected breast (although not always palpable, if deep in breast tissue.

Clinical Course and Management

Patient was started on NIV Support, IV fluids, IV antibiotics (Inj.vancomycin 1gm/ Inj.Piptaz 4.5gm),corticosteroids (Inj.Corts 50 MG(200 mg/day) for septic shock, antipyretics, inotropes (nor adrenaline infusion) and insulin infusion initiated as per hyperglycemia.

Since patient had worsening tachycardia and tachypenia, desaturation and due to impending cardiorespiratory failure, patient was intubated and put on ventilator. DVT prophylaxis was followed/general surgeon reviewed the patient and USG screening taken showed residual collection and planned for I&D.

ECHO showed severe LV Dysfunction, IVC Dilated.

Due to worsening sepsis, procedure was planned immediately at bedside, under strict aseptic technique and about 20ml of fluid was drained. Antibiotic was changed, appropriate correction was done, and blood investigation was repeated. Pus culture showed staphylococcus Aureus (MRSA) heavy growth. The general surgeon viewed periodically,wound assessment and sterile dressing was done. Inotropes were tapered and stopped, and patient was weaned and on 6th day patient was extubated. CRP reduced to 10.

Patient was stabilized; wound was healthy, minimal serous drainage. Then shifted to ward and was on treatment, comfortable , hence after three days of observation, patient discharged with following discharge advice.

Condition At Discharge

Vitals stable

Local Examination:

Bilateral breast soft

Wound healthy

Minimal serous discharge (+)

Discharge Medications

S.No	Drug Name	Strength	Frequency	Route	Days
1.	T.LINEZOLID	600mg	BD	ORAL	5
2.	T.CHYMORAL FORTE		TDS	ORAL	5
3.	T.SOMPRAZ	40 mg	OD	ORAL	5
4.	T.LIVOGENZ		OD	ORAL	30
5.	T.B LONG		BD	ORAL	7

Instruction At Discharge

Please come to emergency if you have

Wound site pain, bleeding, swelling, tenderness

Breathlessness, chest pain, abdominal pain, vomiting, loose stools, fever.

Conclusion: Breast infection is common and if managed appropriately it will usually resolve with antibiotics alone. Breast abscess requires minimally invasive aspiration in combination with antibiotics to give the most favorable outcome. If managed appropriately invasive I&D is rarely required when managing an uncomplicated breast abscess. It is important that clinicians in primary and secondary care are aware of the current management pathways and make urgent referrals for any patient for whom resolution does not rapidly occur with a single course of appropriate antibiotics. Delay in referral or appropriate management can have serious consequences for residual morbidity and cosmesis.

References

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A Case Report On Mastitis

A Case Report On Mastitis

J. Sheetal

Supportive Treatment

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