In July 2014, a 59-year-old women was admitted in into the infectious disease department of the University Hospital in Marseille for swollen, erythematous, painful breasts with purulent discharge from surgical wound of left breast prosthesis implantation. Fifteen months after weight-loss surgery and advanced diet per bariatric surgery nutritional procedure for morbid obesity (body mass index 41 kg/m2), she has significant loss of 43 kg (body mass index weight 20 kg/m2). There was nothing else notable in her medical history.
Four weeks before her admission, she underwent breast prosthesis implantation, mastopexy and arm lifting surgery in private clinics in the region. One week after surgery, she presented with thoracic pain and purulent discharge from surgical wound. The laboratory investigations revealed high C-reactive protein levels (74 mg/l; normal values <=5 mg/l), elevated leukocyte count (12,000 muL-1, predominantly neutrophil granulocytes), low hemoglobin concentration (10 g/l; normal = 135-175 g/l), and normal platelet count (480,000 muL-1). The culture of the fluid obtained by percutaneous drainage was positive of Pseudomonas aeruginosa. Symptoms persisted despite of 10 days of oral therapy by ciprofloxacin. Breast prosthesis implant have been removed and intravenous antimicrobial treatment of amikacin and ceftazidime was begun.
Fifteen day later, she had been admitted in our unit for persistent of swelling, reddish, painful left breast and purulent discharge from surgical wound of left breast implant. Her body temperature was 37  C, her pulse was 74 beats/min, and her blood pressure was 127/70 mmHg. Laboratory investigations revealed normal values for C-reactive protein (1 mg/l; normal values <=5 mg/l) and normal leukocyte count (5000 muL-1), low hemoglobin concentration (10 g/l; normal = 135-175 g/l), and normal platelet count (300,000 muL-1). Magnetic resonance imaging (MRI) has shown an inflammation of anterior chest wall in the left side with sternal osteitis (Fig. 1a and b).
She was treated by surgical lavage with debridement, a fistulectomy with costal-chondral resection of infected tissue. The necrotic periosteum and perichondrium tissues and hypovascularized rib were removed (Fig. 1c). A removal of 3rd and 4th left ribs and a partial sternal resection was performed (Fig. 1d). Bacterial cultures of the deep sample were negative. Analyses for S. aureus and M. tuberculosis by PCR and 16S RNA testing were negative. She was discharged one week after surgery. She received 90 days of treatment with imipenem/cilastatin and ciprofloxacin.