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
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 days1. Involvement of the
underlying fascia and subcutaneous tissue may also occur, presenting as
necrotising fasciitis2. This could be fatal with
mortality rates reported between 8 and 70%2.
Therefore, prompt diagnosis and early aggressive treatment is paramount.
The mainstay of surgical treatment includes prompt wound debridement,
necrosectomy, fasciotomy, and mastectomy, if needed2.
Authors and their contributions:
- Dr. Meenakshi Deivanayagam contributed to this work by writing the
manuscript, obtaining consent and reviewing the final version.
- Mr. Sirwan Hadad contributed to this work by revising the manuscript,
organising clinical photography and reviewing the final version.