CALCIFICATION OF THE BREAST FOLLOWING A TYPHOID ABSCESS

Abstract

1. In a patient with typhoid fever, who had taken, during eleven days, 132 grammes of lactate of calcium by the mouth, as well as 5 grammes of chloride of calcium subcutaneously, there developed, eleven days after the subcutaneous infusion, a large abscess of the breast from which Bacillus typhosus and Staphylococcus aureus were obtained on culture. The abscess was opened and the wound packed with iodoform gauze. Eleven days later a deposit of calcium appeared in the granulation tissue bordering the wound. This rapidly increased until the rim of the opening and the lining granulation tissue were converted into a hard, calcareous mass. A number of nodules of an apparently similar character appeared in other parts of the breast. 2. A month later the iodoform packing was removed and the patient was put on a carbohydrate free diet. This was continued for twenty-four of the next thirty-six days. Under this treatment the abscess almost entirely healed with complete disappearance of the deposit of calcium. 3. Studies of the intake and output of calcium showed that, during three days under a diet of milk and eggs there was a material calcium retention (I.346 grammes) : (b) That during two periods amounting to three weeks in all, under a carbohydrate free diet, there was an excess of Ca elimination over the intake of 3.672 grammes, (c) That during ten days following the last carbohydrate free period, under a normal diet, there was a retention of calcium amounting to 0.602 gramme. 4. The disappearance of calcium from the breast was associated in time with the carbohydrate free diet and the excessive elimination of calcium. 3. Under the carbohydrate free diet acetone and diacetic acid appeared on two occasions in the urine, but were not accompanied by any increase in the elimination of calcium. 6. With regard to the cause of the calcification, we cannot speak with certainty. The remarkable association of the deposition of calcium at the seat of an injection of calcium chloride in an individual who had been receiving large quantities of lactate of calcium by the mouth—a deposition occurring in tissues which were in direct connection with or in the immediate neighborhood of a dressing containing iodoform, a poison which in certain animals produces degenerative changes in the kidneys and liver which are peculiarly prone to calcification, is striking and worthy of note. 7. In how far the decalcification of the affected area may have been due to the carbohydrate free regime with the consequent excess in calcium elimination, it is impossible, on the basis of a single case, to say. The coincidence in time of the disappearance of calcium from the breast with this treatment is, however, remarkable and extremely suggestive.