Dear Rene
I have came across several cases of ante partum mastitis occuring in the
last trimester of pregnancy, all had classical symptoms and were treated
routinely with oral antibiotics - except one whose symptoms were very
similar to those you describe. This mother presented with a temp in labor
which immediately post partum rose to 39.5C (?103F) with flu like symptoms.
On examination she had a red painful segment in one breast accompanied by
very angry erythematous (and very fungal looking) rashes under both
breasts.Her nipples appeared normal and intact (as have all of the
antepartum mastitis cases I have seen) She said she had had these rashes for
nearly a week and had not bothered to seek treatment. She required several
days of IV antibiotics and we also treated her with topical and systemic
antifungals.It is interesting that the fungal type rash was present prior to
the onset of the typical mastitic symptoms. It begs the question whether a
fungal infection can cause the typical mastitis symptoms we always presume
to be bacterial or perhaps the presentation of both fungal and bacterial
infections were just coincidental and unrelated (though doubtful I think).
Unfortunately we didnt culture milk samples in this case, might have been
interesting.

Regards
Cathy Retherston RM MSC IBCLC

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