12 May 2025
: Case report 
Managing Necrotizing Soft-Tissue Infection in Breast Cancer: A Case of Emergency Toilet Mastectomy
Management of emergency care, Rare disease
Jessica J. Farzan ABCDEF 1*, Jiddu A. Guart ABCDEF 1, Nichita Kulkarni DE 1, Sarah Roberts DE 1, Gabriel De la Cruz-Ku
DE 1,2, Donald R. Czerniach E 1, Kate H. Dinh AEF 1
DOI: 10.12659/AJCR.946669
Am J Case Rep 2025; 26:e946669
Table 1 Patient characteristics, initial presentation, diagnosis, and treatment.
| Age | 71 years old |
| Gender | Female |
| Race | White |
| Presentation | Right breast: Markedly enlarged, with diffuse erythema, induration, and tenderness on palpation. The inferior aspect exhibited a large, malodorous fungating mass with copious purulent drainage. Pronounced erythema extended laterally, involving the chest wall and flank region |
| Lab results at presentation | K+ 2.7Na+ 128Mg2+ 1.5 mg/dLLactic acid 3.1 mmol/LBlood glucose 307 mg/dLC-reactive protein – less than 15 mg/dLLeukocytosis 32.5 K/μL |
| Past medical history | BMI 31.38 kg/m |
| Social history | The patient has not seen a healthcare provider in over 50 years. She did not smoke, and consumed alcohol occasionally. She was not up to date on breast cancer screenings |
| LRINEC score | 4 |
| SOFA score | 100 mmHg 50% No 339×10/μL 15 1.4 mg/dL 9.07 NE (norepinephrine <0.1 mcg/kg/min) 0.7 mg/dL |
| Immunohistochemistry | ER/P-positive, HER2-negative (ER >75%, PR >75%, HER2 0) |
| Stage | pT4b(m)N0MX |
| Lymph nodes involved | Axillary lymph nodes and left hilar lymphadenopathy |
| Number of lymph nodes resected | None |
| Surgical treatment | Right-sided toilet mastectomy with additional tissue resected from axilla and flank regions |
| Intraoperative cultures | Positive for methicillin-sensitive Staphylococcus aureus |
| Medical treatment | Hormonal therapy with anastrozole was chosen as the primary medical treatment, given that her complex hospital course rendered more aggressive options, such as chemotherapy and radiation, inappropriate |