OK learned ones,
This one is stumping me.
A mom of a 4 week old with what sounds to me like candida with persisting
pain.
I saw her 5/19 and she was complaining of burning pain at the start and
during feeds from her nipple "through the breast into her back"
Baby looked well, mouth clear. Mom's nipples slightly red not abraded nor
cracked.
BTW mom had been in a few days post nursery d/c cc of painful cracked
nipples but had only a small crack tx with Jacks all purpose cream.
On 5/19 I treated mom and baby with 3 days of Gentian violet and mom with
Diflucan 200mg X1 day then 100mg for a 2 week course.
However mom called on 5/24 days no better and Diflucan was increased to
200mg Q day.
Today mom says she had slightly improved a few days but now bad again.
Painful burning shooting pain at start and into most of the duration of
feed. Pain goes from nipple " straight back" also mom states post feed she
gets lateral breast pain into the axilla that feels like an ache. Worse on
the right but present B/L.
Mom says baby drains her well. He is growing very well.
Mom has generalized body ache today but denies fever, and  redness of
breast. She has some lumpiness on the right but is nontender.
Mom says she has past hx of a lot of vaginal yeast infections.
My thinking is yeast, coincidental viral infection and nipple inflamation.
Plan is to finish the Diflucan and also treat mom with mycolog (combo
antifungal/steroid).
Any other ideas/
Thanks,
Rob

Rob Cordes, DO, FAAP, FACOP
Wilkes Barre PA
mailto:[log in to unmask]

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