A new mother was deeply alarmed when one of her breasts turned black due to skin necrosis. The 38-year-old woman discovered a black spot on her breast just 15 days after delivering a premature baby at 22 weeks gestation.
Experiencing troubling symptoms for a day, she sought medical attention at a hospital where she was diagnosed with mastalgia, characterized by breast pain that can feel heavy, tender, or burning, along with erythema (skin redness) and general malaise (discomfort or illness).
Although not breastfeeding at the time, she was pumping milk, which possibly heightened the risk of infection in her breast. She had no history of breast problems, diabetes, or smoking.
An ultrasound revealed no abscess or fluid in her breast, and she was prescribed antibiotics (flucloxacillin). However, within two days, the bruising on her breast worsened significantly, raising concerns about necrotising fasciitis, a severe bacterial infection that rapidly damages skin, fat, and connective tissue.
Further tests showed the presence of MRSA in her breast milk, a resistant bacterial strain. A surgical consultant determined that the condition was most likely group A streptococcus (GAS) erysipelas, a bacterial skin infection. She received antibiotic treatment for both infections and potential necrotising fasciitis.
Fortunately, her condition stabilized, and she was discharged on the fifth day with ongoing treatment at home. Nonetheless, two weeks later, she developed dry necrosis, where tissue dies due to inadequate blood supply. Her wound exhibited dead tissue and fluid, with some milk leakage.
The medical team identified necrotic erysipelas, an uncommon and severe form of erysipelas characterized by skin death. She underwent surgery to remove the dead tissue and received a vacuum closure dressing. Subsequent debridement procedures were necessary until the wound healed and stopped leaking milk.
A month after the initial operation, she underwent skin grafting, which resulted in successful wound healing, leading to her discharge from follow-up care.
She is currently in good health with no further complications. The remarkable case was documented in a medical journal.