Abscess Issues

[Eve]

Hi, I've had a resurgence of Hidradenitis Suppurativa. I found a breast abscess (underside of left breast) a week ago Saturday, quite a nasty one. Was already on Amoxycillin for an ear infection so was changed to Co-Amoxiclav. The abscess burst Monday morning.

Finished the Co-Amoxiclav this last Saturday but another abscess had already started to come up, not as bad as the first one.

I went to the walk in centre on Sunday and saw a nurse, then doctor briefly, another abscess definitely forming as she (nurse examined me) could feel stuff around it. The original one still looks horrible, raised and dark but nurse said that one is empty which is good. They gave me Flucloxicillin, four times a day.

It's been getting increasingly tender (though not in the best place as I'm pretty large chested and underneath the breast). Jut checked it after I got home and there is a warm round raised pink circular patch of skin, about 4cm in diameter, leading off from the new abscess (though they are right next to each other), looks a bit like how the skin was when I had mastitis (as well as an abscess) previously. I've had cellulitis a few times previously although only ever on my legs and foot and from an insect bite.

Just wanted a bit of advice about whether it's something that can wait until tomorrow to see if I can speak to a GP about it then, especially given I'm already on antibiotics. I really don't want to have to go out again tonight if I don't need to as I'm absolutely shattered. I've not had my RA Enbrel injections for a couple of weeks now due to the infections so should be less "compromised" if at all now though I don't know exactly how long it stays in your system.

[Sqad]

You always were and still are a clinical problem.
I think that the first thing that I need to know is if you have had a swab taken to culture the offending organism and it's antibiotic sensitivity.
If you feel well in yourself, then wait until tomorrow to see your GP ( although I guess my post has come too late.)

[slaney]

You are having a bad time of it Eve..
Agree with Sqad, you really need a swab taken to see f you have a resistant bacterial infection or even a fungal infection.
As to how long cell mediated immunity is impaired after the newer treatments such as Enbrel, no one really knows, but it is generally recommended not to have any live vaccines for 6 months after stopping.

[Eve]

So sorry for the late response, it was a very very long day yesterday. Had three other pre-arranged medical appointments yesterday as well as sorting this and was in work first thing.

Thank you both for replying. It's been a trying couple of months, on my sixth lot of antibiotics now since mid October (had an chest infection then ear infection too) which is really not a good situation. Two courses were finished early though as changed.

I phoned the GP yesterday morning as wanted to get my surgery involved as both previous abscesses came up on a weekend so was walk in and out of hours doctors I saw, who can't do swabs, and I think a swab really does need to happen. Not had one yet.

The GP sent me to A&E, they sent me to the hospital walk in saying if I needed referral to the emergency surgical team it would be quicker via them due to the wait in A&E. Walk in said the big pink bit is erythema and a superficial skin infection, so thankfully not cellulitis so I'm very relieved about that.

I've been put back on Co-Amoxyclav and if no better in 24 hours then to go to A&E at a hospital further away where the breast specialists are.

It's still growing and has grown again overnight, quite slowly though, nothing too dramatic, so keeping a close eye on it. So still no swab at the moment.

Can I ask, can it be swabbed even if it hasn't burst? Like over the skin to see what bacteria are around it, or does it need to be from the inside?

Thanks for the information about immunity, 6 months is a lot longer than I had anticipated. It's good to know as it helps to know how much the drugs might be affecting my immune system even when I haven't had injections.

So the plan is to get this infections cleared and this erythema done and get back on my injections as my RA is not happy. Also had it suggested to get my blood sugars done and a referral to dermatology about whether longer term antibiotics or anything else will help the HS. I already wash with Hibiscrub.

Thank you both for replying, I really do appreciate it.

[murraymints]

Eve..Nothing to add.. just to say I hope you find a solution to this soon and feel a bitty better xx

[Eve]

Aww, thanks murray, that really nice of you xxx

Sorry, just reread my essay above, should say 48 hours, not 24 hours.

[Sqad]

Yes...it does not have to be "leaking" to get a swab.......the overlying skin could be swabbed ( not recommended) but a needle easily and painlessly inserted into the area and then cultured would be a better method of attack.

[Eve]

Thanks for that.

Will see if these antibiotics kick in. Early days as only started them yesterday after the Flucloxicillin. The area has doubled in diameter from when I found it, so back from Tuesday night, but hopefully it will start to go down soon.

[Eve]

Hi, just a quick update. Managed to see a specialist breast consultant yesterday and confirmed it is an infection. Had an ultrasound but no puss lurking underneath that needs to be drained and still superficial infection, which is something at least. He thinks the original abscess is the cause of it all. Carrying on with Amoxiclav for now, specialist thinks that will start to clear it. Really hope so. Back to see them this coming week to review it. Its grown again, was 16x11cm yesterday, but just hoping it starts to clear. Come up with a very red bit which feels more raised within the larger infection near the abscesses today so wondering if another is on the way. Still no swab taken yet.

I know Co Amoxiclav is a broad spectrum antibiotic but am assuming there may be bugs it doesn't cover?

A doctor said the other day that it can also lower your immune system but how would it do that? Is it to do with wiping out of good as well as bad bacteria or something like that?

Think I'll be getting on the probiotics after all these courses!!

[Eve]

Arghh! Still there and getting redder round the abscesses still!

[Sqad]

Thanks for the update....still no sign of a swab?

[Eve]

No, no swab yet :( I'm going to try and ask for one when I see the specialists as it just doesn't seem to be reacting to the antibiotics.

At least I'm seeing a specialist now which is great. Was advised to go with Wythenshawe A&E if no better in 48 hours as they have the specialist breast unit there (where my HS was diagnosed). Was so impressed, it was spotless and hardly any wait at all to be triaged and seen. They asked the breast centre (it has it's own newish fancy building even!) for advice and they said to send me over and it was only about 3 hours from me walking in to A&E I was triaged, seen, seen by the breast unit, ultrasounded by a doctor and seen again. They are getting some fantastic feedback for this. So impressed!

[Sqad]

Eve...that is good treatment........

[Eve]

It really was. I even had apologies for my wait at times! I was quite incredulous as to getting apologies for it when it was no time at all really. Especially at the breast centre where they had just fitted me in. Wonderful service. A very pleasant hospital to be in too, NHS as hospitals go! :) They've really made an effort there.

[Eve]

Just an update, saw the specialist again yesterday and he is pleased that the infection is clearing up so no more antibiotics needed, which is a good thing for my body after the six lots I've just had. On to the probiotics.

The affected area is flat now and still a large area and very pink but I'm guessing it's just the skin taking its time to heal itself after the infection. Need it to start shrinking and going back to normal colour now.

Inflammatory breast cancer also ruled out so that is a huge relief! He said the infection is linked to the HS.

So good news :) Going to give it a day or so to make sure it's still settled and then back on my injections which will hopefully settle the HS down again before any more abscesses come up and give me some relief with the RA.

[murraymints]

getting there Eve !! good stuff ! x

[Sqad]

Thanks for the update Eve.