Breast Ulcer | Figure 1

daisy767

Registered Nurse

Breast Ulcer

Case Summary

Atypical presentation of breast skin ulcer. Patient is a 50-year-old female who presents to Urgent Care with complaints of finding this while in the shower. She reported tenderness but no significant pain. Patient history includes hyperlipidemia, GERD, and clinical obesity. There is no indication of diabetes, hypertension, or auto-immune disorders.

The ulcer shows a thick yellow slough that is slightly weepy upon agitation. No induration or suspicious masses upon examination. Culture results indicate 2+ normal skin flora and rare Proteus Mirabilis. The patient is referred for wound care and a mammogram.

Updates

Update 1

After 10 days of Bactrim DS, the ulcer has not fully resolved but has reduced in size. Patient now reports pain and notable purulent drainage. Consults for dermatology may lead to a biopsy.

Update 2

The wound shows significant improvement and is now much smaller. A repeat culture was negative, and an ultrasound confirmed the absence of deep infection or masses. Diagnosis revised to necrotic spider bite.

Update 3

After four weeks, the wound remains open but is nearly closed. Patient experiences no drainage, but edges remain thick. The breast surgeon will monitor and consider biopsy if healing does not occur within three weeks.

Update 4

The wound has finally healed after approximately seven weeks, leaving a large scar which is dark purple. A follow-up ultrasound revealed probable scar tissue, although the patient disagrees with the initially proposed spider bite diagnosis.

For further details, images and discussions, patients and professionals should consult the specific case report or relevant medical literature.