History: A 32 year-old female was hospitalized for treatment of a 4 month history of a painful rash on her left breast associated with fever and progressive swelling and drainage. She had been receiving IV antibiotics for presumed breast cellulitis without improvement. Dermatology was consulted for help in treating the overlying "eczema."
Medications: Vancomycin, Atorvastatin, and Depakote
Past Medical History: Hypercholesterolemia, Bipolar disorder
Family History: The patient's mother was diagnosed with breast cancer around age 50. She had no siblings and her father's family history was uncertain.
Physical Exam: Temperature = 37.1. The patient's left breast was significantly enlarged with diffuse erythema and edema. The overlying skin was indurated and warm with a peau d'orange appearance. An ulceration with purulent drainage was noted. (Figures 1-3.)
Labs: WBC = 9.1. Blood cultures were negative.
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