Visual diagnosis in emergency medicine| Volume 35, ISSUE 2, P207, August 2008

Tooth Fairy Abscess

      A 31-year-old man presented to our Emergency Department with complaints of left breast pain and swelling for 1 week. He stated he had his nipple pierced 10 years ago and continued to keep a plastic loop through it, frequently changing the loop. He denied any recent fevers or chills. His vital signs were normal. Physical examination revealed a warm, erythematous, and fluctuant 2-cm area at the lateral border of the areola. The patient was reluctant to consent for an incision and drainage (I & D) for cosmetic reasons, however, he agreed to an aspiration of the area. Sterile needle aspiration of the area was performed, which elicited 2 cc of pus. The patient was given an intramuscular injection of cefazolin and discharged with a prescription of cephalexin and instructions to follow-up in 2 days. It was explained to him that if the abscess recurred, an I & D would be necessary. The patient was accepting of this, however, he failed to follow-up in the 2 days as instructed.
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