title: Necrotizing soft tissue infection of the breast: case report and literature review.
abstract: BACKGROUND
  Necrotizing soft tissue infection (NSTI) is characterized by progressive infectious gangrene of the skin and subcutaneous tissue. Its treatment involves intensive care, broad-spectrum antibiotic therapy, and full debridement.
  
  
  METHODS
  We present two cases of NSTI of the breast, adding these cases to the 14 described in the literature, reviewing the characteristics and evolution of all cases.
  
  
  METHODS
  On the fourth day after mastectomy, a 59-year-old woman with ulcerated breast cancer developed Type I NSTI caused by Pseudomonas aeruginosa, which had a favorable evolution after debridement and broad-spectrum antibiotics. The second patient was a 57-year-old woman submitted to a mastectomy and axillary dissection, who had recurrent seromas. On the 32nd post-operative day, after a seroma puncture, she developed Type II NSTI caused by β-hemolytic streptococci. She developed sepsis and died on the tenth day after debridement, intensive care, and broad-spectrum antibiotics. The cases are the first description of breast NSTI after mammary seroma aspiration and the first report of this condition caused by P. aeruginosa.
  
  
  CONCLUSIONS
  Necrotizing soft tissue infection is rare in breast tissue. It frequently is of Type II, occurring mainly after procedures in patients with breast cancer. The surgeon's participation in controlling the focus of the infection is of fundamental importance, and just as important are broad-spectrum antibiotic therapy and support measures, such as maintenance of volume, correction of electrolytic disorders, and treatment of sepsis and septic shock. Once the infection has been brought under control, skin grafting or soft tissue flaps can be considered. The mortality rate in breast NSTI is 18.7%, all deaths being in patients with the fulminant Type II form. Surgical oncologists need to be alert to the possibility of this rare condition.
authors.affiliation: Department of Surgical Oncology, Barretos Cancer Hospital, Barretos, Brazil. reneacv@terra.com.br
authors.forename: René
authors.initials: R
authors.lastname: Aloisio da Costa Vieira
authors.forename: Angelo Gustavo
authors.initials: AG
authors.lastname: Zucca Mathes
authors.forename: Rodrigo Augusto Depieri
authors.initials: RA
authors.lastname: Michelli
authors.forename: Gustavo Henrique Fabri Pereira
authors.initials: GH
authors.lastname: Ribeiro
authors.forename: Raphael Luiz
authors.initials: RL
authors.lastname: Haikel
authors.forename: Cristiano Ribeiro
authors.initials: CR
authors.lastname: Viana
authors.forename: Paulo de Tarso Oliveira
authors.initials: Pde T
authors.lastname: Castro
authors.forename: Gilberto
authors.initials: G
authors.lastname: Uemura
mesh_terms: D016470:Bacteremia; D001943:Breast Neoplasms / Q000382:microbiology / Q000601:surgery*; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000382:microbiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000209:etiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D018461:Soft Tissue Infections / Q000209:etiology* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*