Necrotising Fasciitis – Clinical Case 2

A 30-year-old woman presents 1 week after an elective caesarean section with 24-hour history of an exquisitely painful, swollen right breast. She reports mixed feeding her new-born. She had no significant past medical history and took no regular medications. She was found to be hypotensive and tachycardic, with a BP of 95/60 and a HR of 130. Initial lab results revealed a WCC of 16.7, a CRP 190, a sodium of 143, urea of 10.3, a creatinine of 151, lactate of 4.1 and a blood glucose of 12.1. Her breast was tense and slightly red, though very tender to palpation. A provisional diagnosis of mastitis complicated by septic shock was made, and she was commenced on appropriate broad-spectrum antibiotics and IV fluid resuscitation. After 2 hours in the department blistering is noted to the skin of her right breast and a repeat lactate showed a rise to 5.9. At this stage a diagnosis of necrotising fasciitis was considered, and urgent surgical referral for debridement made.