Differential Diagnosis for Breast Pain in a 36-year-old Postpartum Woman
- Single most likely diagnosis + Mastitis: This is the most likely diagnosis given the patient's symptoms of breast pain, fever, chills, and physical examination findings of erythema, induration, and tenderness in the affected breast, particularly in the context of recent childbirth and breastfeeding. Mastitis is an infection of the breast tissue, commonly seen in lactating women.
- Other Likely diagnoses + Breast abscess: Although the patient does not have fluctuance, which is a classic sign of a breast abscess, it's still a possible diagnosis, especially if mastitis is not promptly treated. The presence of fever, chills, and localized pain increases the suspicion. + Plugged duct: This condition can cause localized pain and sometimes fever, although it's less likely to cause systemic symptoms like chills and high fever. It's a common issue in breastfeeding women and could be considered if the symptoms were less severe.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Inflammatory breast cancer: This is a rare but aggressive form of breast cancer that can mimic mastitis or a breast abscess. It's crucial to consider this diagnosis, especially given the patient's family history of breast cancer, although the patient's age and recent postpartum status make it less likely. + Necrotizing fasciitis: Although extremely rare, this condition is a medical emergency. It could present with severe pain, erythema, and systemic symptoms. The lack of specific findings like crepitus or severe pain out of proportion to examination findings makes this less likely, but it should always be considered in cases of severe infection.
- Rare diagnoses + Granulomatous mastitis: This is a rare inflammatory condition of the breast that can mimic infection or cancer. It's more commonly seen in non-lactating women but should be considered if initial treatments for mastitis or abscess fail and biopsy is necessary. + Tuberculous mastitis: This is a rare condition in many parts of the world but should be considered in endemic areas or in patients with risk factors for tuberculosis. It can present with chronic infection symptoms and might not respond to standard antibiotic treatments.