# Fungating Breast Carcinoma Complicated by Carbapenem-Resistant Pseudomonas aeruginosa Infection in a Patient With Severe Blood-Injection-Injury Phobia: A Case Report

## TL;DR

A woman with a severe fear of blood and injections delayed treatment for advanced breast cancer complicated by a rare antibiotic-resistant infection.

## Contribution

This case report highlights the intersection of advanced fungating breast cancer, CR-PSA infection, and psychological barriers to care.

## Key findings

- Fungating breast tumors can be complicated by carbapenem-resistant Pseudomonas aeruginosa infection.
- Severe BII phobia can delay diagnosis and treatment, leading to advanced disease and sepsis.
- Multidisciplinary care is essential in managing complex cases involving both oncologic and infectious disease challenges.

## Abstract

Fungating breast tumors represent advanced breast cancer and are frequently complicated by secondary infection. While bacterial colonization is common, infection with carbapenem-resistant Pseudomonas aeruginosa (CR-PSA) in breast wounds is rare and poses significant therapeutic challenges. We report the case of a 60-year-old woman who presented with a six-month history of a progressively enlarging fungating right breast mass, with delayed evaluation due to severe blood-injection-injury (BII) phobia. On admission, she was septic and profoundly anemic. Imaging demonstrated a large exophytic breast mass with bilateral axillary lymphadenopathy, and biopsy confirmed grade 3 invasive mammary carcinoma. Wound cultures grew CR-PSA, necessitating intravenous antibiotics, surgical debridement, and targeted antimicrobial therapy. Her clinical course required blood transfusions and multiple specialities consulted prior to stabilization and discharge for outpatient oncologic care. This case highlights the potential for fungating breast tumors to harbor multidrug-resistant organisms and illustrates how psychological barriers to care can contribute to advanced disease and complex clinical presentations.