Differential Diagnosis
- Single most likely diagnosis
- Mastitis: This is the most likely diagnosis given the patient's symptoms of breast pain, lump, fever, chills, redness, and swelling, particularly in the context of breastfeeding. The presence of a cracked nipple, which can serve as a portal of entry for bacteria, further supports this diagnosis.
- Other Likely diagnoses
- Breast abscess: This could be considered if the mastitis has progressed to form a localized collection of pus. The firm, tender mass and swelling in the upper inner and outer quadrants of the left breast could be indicative of an abscess.
- Plugged duct: Although less likely given the systemic symptoms like fever, a plugged duct could cause a lump and pain. However, the presence of fever and chills points more towards an infectious process like mastitis.
- Eczema/dermatitis of the nipple: The cracked nipple with a white appearance could suggest a dermatological condition, but the systemic symptoms and the breast lump make this less likely as a primary diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Inflammatory breast cancer: Although rare and less likely in a young breastfeeding woman, inflammatory breast cancer can present with similar symptoms of redness, swelling, and warmth of the breast. It is crucial to consider this diagnosis to ensure prompt investigation and treatment if necessary.
- Necrotizing fasciitis: This is a severe infection of the skin and subcutaneous tissue that can rapidly progress and is life-threatening. While the current symptoms do not strongly suggest this condition, any signs of severe infection or rapid deterioration should prompt consideration of necrotizing fasciitis.
- Rare diagnoses
- Granulomatous mastitis: A rare condition characterized by granulomatous inflammation of the breast tissue, which can mimic infectious or malignant processes. It is less common and might be considered if initial treatments for mastitis or abscess are not effective.
- Breast tuberculosis: Although rare in many parts of the world, breast tuberculosis can present with a variety of symptoms including breast lumps, pain, and systemic symptoms like fever. This diagnosis would be more likely in areas where tuberculosis is endemic or in individuals with a high risk of exposure.