Case of Necrotizing Soft Tissue Infection of the Breast Caused by Group A Streptococcus

Abstract

Our case involved an 83-year-old woman with diabetes who underwent pacemaker implantation for sick sinus syndrome and was prescribed dabigatran. While she worked on loading for farming, the right chest pain developed. She was unable to raise her right hand ; the next day, she visited the emergency department. At the first medical examination, her breast had flare and swelling. Computed tomography showed elevated subcutaneous fat density in her right breast and swelling of the greater pectoral muscle. Initially, we suspected intramuscular hematoma induced by anticoagulant use. Five hours after consultation, her blood pressure suddenly dropped, and intubation and intensive care were initiated. The muscular fascia was biopsied, and microscopic examination of the specimen revealed Gram-positive cocci in pairs and chains. The antigen detection test for Group A Streptococcus was positive. We diagnosed necrotizing soft tissue infection (NSTI) caused by Group A Streptococcus and started administering antimicrobials ; we also performed surgical debridement of the precordial region, including the right breast, right neck, and right upper arm. However, she died one day later due to septic shock. NSTIs are fatal and frequently develop in the extremities ; spread of NSTI to the breast is unusual. Herein, we reported a case of NSTI of the breast and reviewed the related literature.