What is the most likely diagnosis for a postpartum woman with bilateral breast pain, fatigue, and difficulty breastfeeding, who is also experiencing hyperthermia (elevated temperature), tachycardia (elevated pulse), and has a history of gestational diabetes mellitus (GDM) and a recent progestin-containing subcutaneous implant (e.g. progestin) placement for contraception?

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Differential Diagnosis

  • Single most likely diagnosis
    • Breast engorgement: This is the most likely diagnosis given the patient's symptoms of bilateral breast pain, full and erythematous breasts, and difficulty with breastfeeding. Breast engorgement is a common condition in the postpartum period, especially in women who are having trouble with breastfeeding.
  • Other Likely diagnoses
    • Mastitis: This is an infection of the breast tissue, which can cause pain, erythema, and swelling. While the patient's temperature is normal, mastitis can occur without fever, especially in the early stages.
    • Plugged duct: A plugged duct can cause localized pain, swelling, and erythema, and can be a precursor to mastitis.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Breast abscess: A breast abscess is a serious infection that can cause severe pain, swelling, and erythema, and can lead to sepsis if left untreated.
    • Necrotizing fasciitis: This is a rare but life-threatening infection that can cause severe pain, swelling, and erythema, and can lead to sepsis and death if left untreated.
    • Pulmonary embolism: While the patient's symptoms are localized to the breasts, it's possible that the patient could be experiencing a pulmonary embolism, which can cause fatigue and tachycardia.
  • Rare diagnoses
    • Inflammatory breast cancer: This is a rare and aggressive form of breast cancer that can cause rapid onset of breast swelling, erythema, and pain.
    • Breast lymphoma: This is a rare type of cancer that can cause breast swelling, pain, and erythema.
    • Granulomatous mastitis: This is a rare inflammatory condition that can cause breast pain, swelling, and erythema.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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