Case 1: Left Breast Swelling in an 11-month-old Girl

Tyler J. Williams; Jennifer Gibson; Lesli Taylor; Demetrio Macariola; Sugantha Krishnan; Callie Reeder

doi:10.1542/pir.2016-0061

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Tyler J. Williams, DO*
Jennifer Gibson, MD^†
Lesli Taylor, MD^†
Demetrio Macariola, MD^†
Sugantha Krishnan, MD^†
Callie Reeder, MD^‡

^*Blue Sky Pediatrics, Asheville, NC
^†East Tennessee State University, Johnson City, TN
^‡University of Tennessee, Knoxville, TN

AUTHOR DISCLOSURE
Drs Williams, Gibson, Taylor, Macariola, Krishnan, and Reeder have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

An 11-month-old girl presents with left breast swelling. Over the last 2 days, the swelling appeared as a small knot and has continued to enlarge (Fig). Her parents report that the swelling has felt warm intermittently, but there is no redness, pain on palpation, or drainage. There is no history of fever, fussiness, or fatigue. The family denies appetite changes and weight loss.

Figure.

Breast swelling.

On physical examination, the girl’s temperature is 98.9°F (37.2°C), heart rate is 127 beats/min, and blood pressure is 108/54 mm Hg. She is playful and in no distress. Chest examination reveals a 4 x 4-cm well-circumscribed, circular, firm, nonfluctuant, mobile mass without erythema or tenderness in the left breast. There is no drainage or lymphadenopathy. Dermatologic examination reveals a severe candidal diaper rash.

Her white blood cell count is 30,400/μL (30.4 × 10⁹/μL), hemoglobin is 12.2 g/dL (122 g/L), hematocrit is 35.3% (0.35), platelet count is 399 × 10³/μL (399 × 10⁹/L), and absolute neutrophil count is 11,248/μL (11.25 × 10⁹/L). Peripheral blood smear does not show any abnormal cells. C-reactive protein is 8.9 mg/L (84.76 nmol/L). Thyrotropin concentration is 6.67 mIU/L, free thyroxine is 1.3 ng/dL …