Necrotising Soft-tissue Infection of the Breast: Case Series of a Rare but Fatal Entity

Abstract

Necrotising Soft-tissue Infection (NSTI) of the breast is an exceedingly rare but highly aggressive condition that constitutes a true surgical emergency. It leads to extensive tissue necrosis, systemic toxicity and can be fatal if not treated promptly. The present case series includes seven patients, ranging in age from 30 to 55 years, all of whom presented with severe breast NSTI. These cases involved a variety of presentations, from sudden gangrene with maggot infestation to severe infections affecting multiple regions, such as the breast, axillae and upper arms. Laboratory findings commonly included elevated White Blood Cell (WBC) counts, while radiological imaging {ultrasound, Computed Tomography (CT) scans} identified extensive tissue damage and abscess formation. Surgical management consisted of extensive debridement and, in some cases, mastectomy with reconstruction. The clinical features across cases included pain, swelling, blackening of the skin, gangrene and purulent discharge. Blood cultures revealed pathogens such as Enterococcus, E. coli and Proteus mirabilis. Management involved intravenous antibiotics (piperacillin-tazobactam, vancomycin and others), debridement and wound care, with some patients requiring forequarter amputation or total mastectomy. In the present case series, 3 out of seven patients (42.8%) succumbed to death despite aggressive treatment. The mortality rate was high due to rapid progression to septic shock and multiorgan failure in some patients. Breast NSTI is a rare but fatal condition that requires early diagnosis and urgent intervention to reduce mortality. Surgical debridement and tailored antibiotic therapy are essential for successful outcomes. The present case series underscores the importance of early identification and the aggressive management of NSTI while highlighting the variable patient responses and the need for ongoing research to improve clinical outcomes.

Keywords

• gangrene
• maggot infestation
• mortality
• tissue necrosis