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IJCRI 2011;2(5):26-28. Runagirinathan et. al.
26
www.ijcasereportsandimages.com
IJCRI – International Journal of Case Reports and Images, Vol. 2, No. 5, May 2011. ISSN – [0976-3198]
ABSTRACT
Introduction: Neonatal mastitis and breast
abscesses are uncommon. The most common
causative agent is Staphylococcal aureus. Case
Report: A case of bilateral breast abscess due
to Methicillin resistant staphylococcus aureus
(MRSA) in a 11-day-old newborn baby, which
responded well to surgical drainage and
injection vancomycin is reported due to its rare
presentation. Conclusion: Complications of
neonatal mastitis are rare but have been
reported. It is therefore essential to treat
neonatal breast abscess aggressively including
antibiotics and surgical drainage.
Keywords: Breast abscess, Mastitis, Neonates,
MRSA
*********
Arunagirinathan A, Duraipandian J, Rangasamy G,
Shivekar S, Saban P, Shivekar S. Bilateral breast
abscess in a neonate – A case report. International
Journal of Case Reports and Images 2011;2(5):26-28.
*********
doi:10.5348/ijcri-2011-05-35-CR-5
INTRODUCTION
Neonatal breast enlargement is common and
probably due to fall in the level of maternal oestrogen
at the end of pregnancy which triggers the release of
prolactin from the pituitary gland of the newborn [1].
It is often self limiting. Neonatal mastitis and breast
abscess are uncommon. Manipulation of the breast
tissue can lead to mastitis and breast abscess [2].
Early
cases of mastitis usually resolve with use of antibiotics
but when abscess is formed surgical drainage is
needed. Infection is localized but can lead to cellulitis,
fasciitis, osteomyelitis, brain abscess and generalized
sepsis [3].
CASE REPORT
A 11-day-old female baby was admitted with
complaints of swelling of both breasts of three days
duration and fever of two days duration. The swelling
was noted by the mother initially on the right side and
later on the left side (Figure 1). The child was a full
term normal baby delivered vaginally. The first week of
neonatal period was normal. Swelling was noted
initially on day eight around the right breast spreading
to adjacent areas of the chest and followed by swelling
of the left breast.
On examination at admission the child was febrile
but active with swelling of both the breasts. The
swelling on the left side was fluctuant. The abscess
B
ilateral breast abscess in a neonate
–
A
case report
Arulkumaran Arunagirinathan, Jeyakumari Duraipandian
Gopal Rangasamy, Smita Shivekar, Prachi saban, Sunil Shivekar
CASE REPORT
OPEN ACCESS
Arulkumaran Arunagirinathan
1
, Jeyakumari
Duraipandian
2
, Gopal Rangasamy
2
, Smita Shivekar
3
,
Prachi saban
3
, Sunil Shivekar
3
Affiliations:
1
Associate Professor, Department of
Pediatrics, Sri Manakula Vinayagar Medical College and
Hospital, Madagadipet, Puducherry, India;
2
Professor,
Department of Microbiology, Sri Manakula Vinayagar
Medical College and Hospital, Madagadipet, Puducherry,
India;
3
Assistant Professors, Department of Microbiology,
Sri Manakula Vinayagar Medical College and Hospital,
Madagadipet, Puducherry, India.
Corresponding Author: Dr. Jeyakmari Duraipandian,
Professor, Department of Microbiology, Sri Manakula
Vinayagar Medical College and Hospital, Madagadipet,
Puducherry -605107, India; Phone: 91- 9865587080;
Office: 91-0413- 2643000-2031; Fax: 91-0413-2643014;
Email: karailabscuddalore@yahoo.co.in
Received: 26 January 2011
Accepted: 04 April 2011
Published: 31 May 2011
IJCRI 2011;2(5):26-28. Runagirinathan et. al.
27
www.ijcasereportsandimages.com
IJCRI – International Journal of Case Reports and Images, Vol. 2, No. 5, May 2011. ISSN – [0976-3198]
was incised and 50 ml of pus drained and sent for
culture and sensitivity (Figure 2A, B). The patient was
empirically put on injection augmentin and amikacin.
Culture of the aspirated pus yielded a pure growth of
MRSA which was sensitive to vancomycin, linezolid
and erythromycin and resistant to penicillin, oxacillin,
ciprofloxacin and co-trimoxazole. Blood culture was
sterile at 72 hrs of incubation. Total count of WBC was
43,200/cmm with polymorphs – 50%, lymphocytes –
45%, monocytes – 4% and eosinophils – 1%,
hemoglobin, platelet count, urea, creatinine, glucose
were normal. C-reactive protein level was raised. The
patient was put on injection vancomycin intravenously,
8
-
hourly following the issue of culture report and
continuing profuse discharge of pus. The discharge of
pus gradually decreased on left side within the next
seven days. The residual abscess on the right side was
drained surgically. The discharge ceased on right side
after one week following the drainage. The child was
discharged with complete cessation of pus from both
the breasts after treatment with injection vancomycin
for ten days and surgical drainage. The child was active
and feeding well and afebrile at the time of discharge.
Papular lesions were seen over the trunk on the tenth
day of discharge which was diagnosed as “Erythema
toxicum” by the dermatologist and advised topical
application of calamine lotion. The child was
discharged with advice to be brought for review after a
week. The child was healthy and had no discharge of
pus during the review seven days after discharge.
DISCUSSION
Neonatal breast abscess is uncommon and usually
unilateral with no systemic symptoms. In the present
case the patient was febrile which is rare as reported by
Rudoy in their study of a series of cases [4]. Neonatal
mastitis is seen in term infants with a peak incidence at
approximately three weeks of age.
The most common causative agent is
Staphyloccocus aureus [3] as was the case in our
patient. Bilateral involvement is uncommon and fever
is seen in less than 50% of patients and leucocytosis in
less than 75% of patients [4, 5 ,6]. Our patient had
fever, leucocytosis and bilateral involvement of breast.
Early cases of mastitis usually resolve with use of
antibiotics but when an abscess is formed surgical
drainage is needed [5]. Aspiration was done in addition
to use of antibiotics as the abscess failed to resolve
with antibiotics alone. Complications of neonatal
mastitis are rare but cellulitis, fasciitis, osteomyelitis,
brain abscess and sepsis have been reported [3].
CONCLUSION
It is therefore essential to treat neonatal mastitis
aggressively with antibiotics including surgical
drainage in refractory cases [5] as in our patient to
Figure 1: Inflammation and swelling of both the breasts.
Figure 2: A) Incision and drainage from the right breast. B)
Pus pouring out from the left breast.
prevent both local and systemic complications [7]. The
patient was found to be active and healthy during the
review visit after one week with no discharge of pus
and completely normal breast.
*********
Author Contributions
Arulkumaran Arunagirinathan – Conception and
design, Acquisition of data, Analysis and interpretation
of data, Critical revision of the article, Final approval of
the version to be published
Jeyakumari Duraipandian – Conception and design,
Acquisition of data, Analysis and interpretation of
IJCRI 2011;2(5):26-28. Runagirinathan et. al.
28
www.ijcasereportsandimages.com
IJCRI – International Journal of Case Reports and Images, Vol. 2, No. 5, May 2011. ISSN – [0976-3198]
data, Drafting the article, Critical revision of the
article, Final approval of the version to be published.
Gopal Rangasamy – Conception and design,
Acquisition of data, Analysis and interpretation of
data, Drafting the article, Critical revision of the
article, Final approval of the version to be published.
Smita Shivekar – Analysis and interpretation of data,
Critical revision of the article, Final approval of the
version to be published.
Prachi Saban – Analysis and interpretation of data,
Critical revision of the article, Final approval of the
version to be published.
Sunil Shivekar – Analysis and interpretation of data,
Critical revision of the article, Final approval of the
version to be published.
Guarantor
The corresponding author is the guarantor of
submission.
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© Jeyakumari Duraipandian et. al. 2011; This article is
distributed under the terms of Creative Commons
attribution 3.0 License which permits unrestricted use,
distribution and reproduction in any means provided
the original authors and original publisher are properly
credited. (Please see www.ijcasereportsandimages.com
/copyright-policy.php for more information.)
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Bailey and Love’s Short Practice of Surgery,
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2. Ramachandraiah A. Neonatal mastitis. Indian
paediatrics 2000; 37:1021.
3. Borders H, Mychaliska G, Gebarski KS. Sonographic
features of neonatal mastitis and breast abscess.
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4. Rudoy RC, Nelson DN. Breast abscess during the
neonatal period. A review. Am J Dis Child 1975;
129(9):1031-1034.
5. Efrat M, Mogilner JG, Iujtman H, Eldemberg D,
Kunin J, Eldar S etal. Neonatal mastitis- diagnosis
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6. Walsh M, Mc Intosh K. Neonatal mastitis.Clin
paediatric 1986; 25:395-399.
7. Stricker T, Navrati F, Sennhauser PH. Mastitis in
Early infancy. Acta paediatrica 2005; 94:166-169.
