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\begin{document}

\title{Idiopathic gangrene of the breast}



\author[1]{Sirwan Hadad}%
\author[2]{Meenakshi Deivanayagam}%
\affil[1]{Sheffield Teaching Hospitals NHS Foundation Trust}%
\affil[2]{Northern Lincolnshire and Goole Hospitals NHS Trust}%


\vspace{-1em}



  
  \date{June 18, 2024}


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\begin{abstract}
An 88-year-old lady presented with idiopathic sepsis and ischaemic
gangrene of the right breast. Group-A bacteraemia was identified on
blood culture. Breast biopsies taken were negative for malignancy. The
patient was treated with intravenous antibiotics and fluid
resuscitation. Subsequent wound care and continuation of oral
antibiotics led to complete recovery.%
\end{abstract}%



\sloppy


Title: Idiopathic gangrene of the breast.

Authors: Meenakshi Deivanayagam (MD) and Sirwan Hadad (SH)

Institution: Department of Breast and Plastics, Sheffield Teaching
Hospitals NHS Foundation Trust, and The University of Sheffield,
Sheffield, UK

Corresponding Author: Sirwan Hadad

4 Claremont Place

Sheffield S10 2TB

s.hadad@nhs.net

Source of funding: None

Manuscript category: Clinical Imaging

The paper is not based on previous communication to a society or meeting

\textbf{Keywords:} Breast Gangrene, Diabetes, Sepsis.

Key Clinical Message: Gangrene of the breast is a rare condition. It is
usually unilateral and can be idiopathic or secondary to puerperal
sepsis, trauma and/ or diabetes. Treatment involve antibiotics, wound
care and resuscitation.

Q: What is this condition?

A: Idiopathic gangrene of the breast. This 88-year-old lady presented
with idiopathic sepsis and ischaemic gangrene of the right breast (Fig.
1). Group-A bacteraemia was identified on blood culture. Breast
ultrasound scan showed an area of centrally located attenuation. The
biopsies taken were negative for malignancy. The patient was treated
with intravenous antibiotics and fluid resuscitation.

Once it is well-demarcated, the gangrenous patch was removed and the
wound cleaned, debrided and treated with silver nitrate. Subsequent
wound care and continuation of oral antibiotics led to complete recovery
(Fig. 2).

The course of the disease begins with skin changes similar to ecchymosis
and abscess, which then progresses to dermal gangrene and eventual
eschar formation over 2-5 days\textsuperscript{1}. Involvement of the
underlying fascia and subcutaneous tissue may also occur, presenting as
necrotising fasciitis\textsuperscript{2}. This could be fatal with
mortality rates reported between 8 and 70\%\textsuperscript{2}.
Therefore, prompt diagnosis and early aggressive treatment is paramount.
The mainstay of surgical treatment includes prompt wound debridement,
necrosectomy, fasciotomy, and mastectomy, if needed\textsuperscript{2}.

Authors and their contributions:

\begin{enumerate}
\tightlist
\item
  Dr. Meenakshi Deivanayagam contributed to this work by writing the
  manuscript, obtaining consent and reviewing the final version.
\item
  Mr. Sirwan Hadad contributed to this work by revising the manuscript,
  organising clinical photography and reviewing the final version.
\end{enumerate}

\emph{References}

\begin{enumerate}
\tightlist
\item
  Agarwal S, Jayant K, Agarwal R. Breast gangrene: a rare source of
  severe sepsis. BMJ Case Rep. 2014;2014: bcr2013203467.
\item
  Yaji P, Bhat B, Harish E. Primary necrotising fasciitis of the breast:
  Case report and brief review of literature. J Clin Diagn Res.
  2014;8(7):ND01--ND02. Figure Legends: Figure 1: Ischaemic gangrene of
  right breast following group A bacteraemia. Figure 2: Resolved
  ischaemic gangrene of right breast after four months.
\end{enumerate}\selectlanguage{english}
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