Mastitis in Adolescents: Acknowledging New Risk Factors

Introduction: Mastitis is uncommon in pediatrics and can be associated with breast abscess. In young nulliparous women there is a causal relationship with smoking habits, due to ductal and periductal inflammation. Disease severity and invasion is higher in the presence of risk factors such as cystic breast lesions. Clinical severity and treatment resistance results from poor penetration of antibiotics into breast tissue.

Case report: 17-year-old adolescent, nulliparous, menarche at age 12, with regular menses and not on oral contraceptive medication. Denied tobacco or other consumptions but exposed to second-hand smoke since early childhood. History of breast asymmetry since puberty, with an epidermoid cyst in her right breast diagnosed at 16 years of age. The patient presented acutely to the emergency department in March 2018, with painless heat and swelling of the right breast. Physical examination revealed a firm and well-defined tumefaction of the right breast, painful on palpation. No axillary lymph nodes were palpable. Breast ultrasound was performed due to the adolescent’s medical history and breast inflammatory signs, which revealed a 13mm epidermoid cyst with adjacent fat densification and fluid collection suggestive of mastitis. Started on oral flucloxacillin, the lesion presented a slow and gradual, however incomplete, reduction in size and inflammatory signs, with resolution only after 6 weeks of antibiotic treatment and surgical drainage.

Discussion: We present this case report as it is uncommon for a nulliparous adolescent to develop mastitis, thus considering the likely impact of second-hand smoke on its pathogenesis, as active smoking is considered a major risk factor for breast inflammatory lesions. In conclusion, we emphasize how tobacco exposure not only has a role on the development of comorbilities such as lung cancer and chronic pulmonary disease, but also other less frequent but equally severe pathological conditions in younger age groups, reinforcing smoke-free environments for children.