Perplexing Presentation: Pink Breast Milk

Background:

The review of the literature has identified S. marcescens as an ‘opportunistic pathogen’ with strong evidence of its role in nosocomial infections. It has been cultured from hospital equipment including breast pumps and inhalation devices (Moloney , Quoraishi , Parry, &  Hall, 1987; Gransden , Webster,  French , & Phillips, 1986;  Cullen, Trail, Robinson,  Keaney, M & Chadwick, 2005) In addition, it can be transmitted from the hands of health care workers. Archibald, Corl, Shah, Shulte, Arduino, Aguero, Stechenberg, Fisher, Stachenberg, Banerjee, and Jarvis  (1997) reported a S. marcescens outbreak in a newborn intensive care nursery (NICU) that was traced to the contamination of health care worker’s personal bottles of 1% chlorxylenol soap which were left open in work areas.

Case:

During a routine six week postpartum visit a mother reported a bright pink stain on her beast pads, burp pads, and baby’s diapers.  The same bright pink color was in her bottles and breast pump when they were left out. The review of systems was negative.  Her history was positive for right breast mastitis postpartum day #4 which was treated appropriately and resolved. Her infant was healthy and thriving. The nurse practitioner (NP) caring for her was perplexed by this presentation. She consulted with the Ob-Gyn staff and the lactation specialist who were also puzzled.   Additionally, a consult was made to a breast specialist in general surgery who consulted with infectious disease (ID) and pediatrics.  The workup included cultures of the mother’s breast pads, milk, and breast pump.  S. marcescens was isolated in addition to common gram negative and positive bacteria. The working diagnosis was colonization of Serratia marcescens without acute infection. The mother was reassured and encouraged to continue breastfeeding. Both she and her infant were closely monitored and managed without antibiotics

Conclusion:

This case provides an example of a unique clinical presentation, involving unusual bacteria, of a breastfeeding mother.  The workup and management was addressed through a multi-disciplinary approach.  Having the input of the different disciplines provided the working diagnosis thus eliminating breast pathology and acute infection. The patient was given guidance regarding proper care of the breast pump and reassured that she could continue to breastfeed. At her final visit she was breastfeeding 60% of the time and baby was thriving.

Keywords: Postpartum, Breastfeeding, infection, Serratia Marcescens