A woman called today to ask my advice.  She relates that at 10 days
postpartum she developed what her midwives diagnosed as bilateral
mastitis, and was treated with a 10 day course of Dicloxacillin.  She
relates that she has inverted nipples, so was wearing "a too tight bra and
nipple shields" in an attempt to improve the ease of the baby's latch.
Initially she developed a 101.5 fever and bilateral breast redness,
warmth, and pain throughout both breasts except where the nipple shield
covered.  She stopped the use of the shields, purchased a well fitting
bra, and started the antibiotic.  Symptom improvement occurred after 5
days.  Upon completion of the first course of antibiotics she noted the
breast tissue remained tender to touch, especially the lower half
bilaterally.  The fever had resolved. The right breast had a "wedge" of
inflamed tissue at 9 o'clock.  She then underwent a 10 day course of
Keflex with improvement seen in the "wedge" area.  Now, on day 21 she has
developed a circular area of breast tissue at 3 o clock on the right
breast and the lower half of the breasts remain tender, no warmth or
redness.  She relates the nipples are intact and nontender, she has
recently weaned the baby off of a breast shield, and she has the most
difficulty latching on the right side.  She reports let-down "stings".
She recently had a normal bilateral breast sono.  I have never
encountered "bilateral generalized mastitis", am wondering about other
possible causes.  We are exploring whether there is a yeast component.
Your collective wisdom is requested!

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