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BACKGROUND
Parents bring their 28-day-old female neonate to the emergency department with a 1-week history of
progressive erythema and swelling of her left nipple and breast. The mother reports the child has had no trauma to the
breast, nipple discharge, or fevers; however, the patient has had decreased oral intake and tenderness of the affected
breast.
The area is not responding to a regimen of cephalexin that the patient's pediatrician prescribed 3 days
ago. The patient was born by means of caesarean delivery; the rest of her perinatal history is unremarkable.
Physical examination reveals an afebrile and well-appearing infant in no obvious distress. The left breast (see Image 1) is
warm and tender, with an underlying area of fluctuance. Other findings are normal. Laboratory tests reveal a slightly
elevated WBC count.
What is the diagnosis?
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Hint
Other family members have recurrent skin infections. The patient's mother has a wound infection at the incision site of the caesarean delivery.
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Author:
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Jennifer A. Jewell, MD,
Clinical Assistant Professor,
Department of Pediatrics,
University of Vermont School of Medicine,
The Barbara Bush Children's Hospital at Maine Medical Center
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eMedicine
Editor:
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Erik D. Schraga, MD,
Department of Emergency Medicine,
Kaiser Permanente,
Santa Clara Medical Center, Calif
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