Fasciitis of the Breast, Ranging from Necrotizing to Non-Necrotizing Forms: A Diagnostic Dilemma Necessitating Vigilant Clinical Scrutiny

Necrotizing soft tissue infections (NSTIs) are rare but highly aggressive infections characterized by rapid necrosis of the skin, subcutaneous tissue, and fascia. While typically seen in the abdomen, perineum, and extremities, NSTIs of the breast are uncommon and often misdiagnosed as cellulitis, mastitis, or abscess, contributing to delayed treatment and high morbidity and mortality. In this series, four patients presented with varying severity of breast NSTIs. Two diabetic patients had delayed presentations and required mastectomy, among whom one succumbed to overwhelming sepsis and multi-organ failure despite aggressive debridement and systemic antimicrobial treatment. A third patient with acute viral infection developed extensive chest wall inflammation concerning for necrotizing myositis requiring surgical exploration and debridement. The last case is of a lactating woman, who presented early and responded well to antibiotics alone and was spared the need for surgical intervention. These cases highlight the broad clinical spectrum of breast NSTIs and emphasize that early recognition and prompt antibiotic therapy with timely surgical debridement are critical for reducing morbidity and mortality of this rare yet aggressive disease in the breast.