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Breast abscess as initial manifestation of extensive DCIS: a rare presentation and literature review

Forty-year-old pre-menopausal woman without prior history of breast disease presented with a 2-day history of left breast pain, enlargement, and subjective fevers and chills. Her examination was notable for an asymmetrically enlarged, exquisitely tender, erythematous left breast with purulent nipple discharge. On laboratory analysis, she had a significant leukocytosis of 32 000 with bandemia. Initial imaging (sonogram and contrast-enhanced CAT scan, Figure 1) showed marked parenchymal edema predominantly involving the upper inner left breast without evidence of discrete mass, fluid collection, or abscess. She was promptly taken to the operating room for incision, drainage, and washout. Additionally, a sample of the breast tissue was excised and sent for pathology. Post-operatively her wound cultures grew pan-sensitive Escherichia coli, and her final pathology unfortunately revealed high-grade, estrogen receptor and progesterone receptor positive ductal carcinoma in situ (DCIS). Subsequent workup demonstrated