• Case Study # 1:

  Case Study # 1:

  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) is warm and tender, with an underlying area of fluctuance. Other findings are normal. Laboratory tests reveal a slightly elevated WBC count.

  

  1.  What is the diagnosis?

  2.  What is the causative organism?

  Hint: The patient’s mother has a wound infection at the incision site of the caesarean delivery.
• 

  Case Study # 2:

  Case Study # 2:

  An 8-year-old is brought by her mother to the office because of vaginal bleeding for 2 weeks. The girl states she has not taken any medication and no Hx suggestive of sexual abuse or activity. No headaches or visual disturbances and she has been doing well in school. The girl is normal for her age without pubertal changes.

  1.  What is the most common cause of her bleeding?
• 

  Case Study # 3:

  Case Study # 3:

  ID/CC A 35 year old female rushes to the emergency room and waits to see a doctor because she is concerned about a bloody nipple discharge that she discovered this morning.
  HPI She exercises, is very health conscious, and always has safe sex.
  PE Palpation around the left nipple reveals blood coming from one of the duct openings and a small, soft lump beneath areola; no breast masses or axillary lymphadenopathy.

  

  1.  What is the Diagnosis?
• 

  Case Study # 4:

  Case Study # 4:

  ID/CC A 4 year old female is brought by her mother to the pediatric clinic after she finds blood and a “lump” in the child’s vagina

  HPI The child’s father died of brain cancer, and her mother is receiving treatment for breast cancer. Her grandfather died of metastatic colorectal cancer

  PE Ulcerated, polypoid, grape-like mass arising from wall of vagina on vaginal speculum exam. (See the picture).

  

  1.  What is the Diagnosis?
• 

  Case Study # 5:

  Case Study # 5:

  ID/CC A 73 year old woman is brought to a gynecologist by her daughter, who became aware of a genital ulcer while helping her mother shower.

  HPI Her history reveals weight loss and dyspnea together with hypertension and arthritis.

  PE Hard, nodular 5 mm pigmented and ulcerated lesion on upper left labia minora; no inguinal lymphadenopathy; scattered crepitant rales on chest auscultation.

  1.  What is the Diagnosis?
• 

  Case Study # 6:

  Case Study # 6:

  ID/CC A 60 year old obese, nulliparous white female presents with intermittent postmenopausal vaginal bleeding of three months’ duration

  HPI She has a history of diabetes, hypertension, and infertility with polycystic ovaries; menopause began at 56 years of age

  PE Uterus is not enlarged on bimanual palpation; remainder of physical exam unremarkable.

  1.  What is the next step in management?

  2.  What is the most likely diagnosis?
• 

  Case Study # 7:

  Case Study # 7:

  ID/CC A 27 year old woman who is actively training for a marathon notes a painful lump in the upper outer quadrant of her right breast of two days’ duration.

  HPI No history of fever; no known family history of breast cancer

  PE Retraction of overlying skin in upper outer quadrant of right breast; indurated lesion the size of a lemon in same area; axillary lymph nodes not palpable.

  Mammogram: irregular mass with focal areas of eggshell calcification.

  1.  What is the Diagnosis?
• 

  Case Study # 8:

  Case Study # 8:

  A 70-year-old woman complains of vulvar itching for a year. She has been treated with multiple steroid medications with no relief; she also noted a small painless swelling in her groin region just above the left thigh.

  1.  What is the most common pathology associated with her Sx?

Solution:

Module # 5

Female GU and Breast Disorders – Case Studies & Answers

CASE STUDY # 1:

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.

1. What is the diagnosis?
2. What is the causative organism?

Hint: The patient’s mother has a wound infection at the incision site of the caesarean delivery.

ANSWER

Mastitis Neonatorum with an underlying abscess caused by MRSA (Methicillin Resistant Staphylococcus Aureus).

The suspicion for MRSA is from the high incidence setting, in this case the mother got it probably from the hospital, and the child did not respond to cephalexin, meaning; a nosocomial resistant organism.

Incision and drainage for the abscess, then Clindamycin, Trimethoprim-Sulfamethoxazole (Bactrim) and Rifampin are the antibiotics of choice in this case….. to purchase click the button below