Erythema and heat in the breast without breastfeeding

Specialty: Gynecology and breast.

• Non-puerperal mastitis
• breast cellulitis
• inflammation of the breast outside of the postpartum period
• unilateral breast redness

Why it occurs

• Periductal mastitis (typically associated with smoking due to squamous metaplasia of the lactiferous ducts)
• Non-puerperal breast abscess
• Ruptured breast cyst with neighboring inflammatory reaction
• Inflammatory carcinoma of the breast (aggressive neoplasm that simulates an infectious process)
• Primary skin infection of the breast (cellulitis or erysipelas due to Streptococcus or Staphylococcus)

Initial workup

Urgent breast ultrasound to rule out drainable fluid collections (abscesses). Complete blood count with leukocyte formula, CRP and even procalcitonin if sepsis is suspected. Culture of aspirated material if there is an abscess. Mammography (once the acute inflammatory phase allows compression of the breast). If erythema persists after antibiotic treatment, it is mandatory to perform a skin punch biopsy of the affected area to rule out invasion of the dermal lymphatics by an inflammatory carcinoma.

Standard management

• Amoxicillin/clavulanic acid 875/125 mg orally every 8 hours for 10 to 14 days
• Clindamycin 300-450 mg orally every 8 hours for 10 days — option of choice in patients allergic to penicillin or suspected anaerobes
• Ciprofloxacin 500 mg every 12 hours in suspected gram-negative bacilli
• Ibuprofen 600 mg orally every 8 hours as an anti-inflammatory and analgesic adjuvant (note: perform strict clinical reassessment after 72 hours to rule out inflammatory carcinoma).