What is the diagonosis of this kind of disease?

Parents bring their 28-day-old female neonate to the emergency department with a 1-week history of progressive erythema and swelling of her left nipple and breast. The mother reports the child has had no trauma to the breast, nipple discharge, or fevers; however, the patient has had decreased oral intake and tenderness of the affected breast.

The area is not responding to a regimen of cephalexin that the patient's paediatrician prescribed 3 days ago. The patient was born by means of caesarean delivery; the rest of her perinatal history is unremarkable.

Physical examination reveals an afebrile and well-appearing infant in no obvious distress. The left breast (see Image 1) is warm and tender, with an underlying area of fluctuance. Other findings are normal. Laboratory tests reveal a slightly elevated WBC count.

Hint
Other family members have recurrent skin infections. The patient's mother has a wound infection at the incision site of the caesarean deliver

Given the poor feeding, inflamed left nipple and breast and fluctuant abscess present this is obviously a case of mastitis neonatorum, usually caused by staphylococcus aureus - in this case one resistant to cephalexin.

This one is partially treated and hence the child is not systemically unwell.

The abscess should be incised and drained and the neonate should be placed on an intravenous antibiotic - flucloxacillin would be sufficient for most cases of Staphylococcus aureus but I happen to know the case you are copying from had MRSA, and appears to have surrounding cellulitis.

I would thus use clindamycin +/- rifampicin.

The patient should be admitted to a paediatric surgical ward to observe for the resolution of the illness.

Parents also should be advised to seek treatment with their usual family doctor and to wash frequently and effectively.

The mother, particularly, should be checked for mastitis.

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