A 19-YEAR-OLD NULLIPAROUS CAUCASIAN WOMAN came into our family practice clinic; she was concerned about redness and swelling that had developed in her left breast 2 weeks earlier. She’d gone to a local emergency department 8 days ago with similar complaints, and was treated with azithromycin and cephalexin for presumptive mastitis and possible cat scratch disease. Despite the antibiotics, she said that her symptoms had worsened; she’d developed a dry cough, dyspnea, general malaise, and a fever of 100.6°F.
The patient was a former smoker and had asthma as a child. She said her mother had been diagnosed with premenopausal breast cancer at age 31. She also indicated that she had a cat and that it might have scratched her arm prior to the onset of symptoms.
On exam, the patient was afebrile but tachycardic at 140 beats per minute. She had left axillary lymphadenopathy. Her left breast was indurated, erythematous, and generally edematous (FIGURE 1). There was no nipple discharge or evidence of trauma to the skin. The patient had decreased breath sounds at the bases.
A breast ultrasound (obtained to evaluate for possible abscess) showed only diffuse edema—but no abscess. A chest x-ray (FIGURE 2). showed an anterior and middle mediastinal soft tissue mass with a left-sided pleural effusion.
The patient was admitted to the hospital for further evaluation.
FIGURE 1
Induration, erythema, and diffuse edema of left breast
FIGURE 2
Chest x-ray reveals left pleural effusion, mediastinal mass
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