Fournier gangrene

Key Clinical Message

Fournier gangrene is a rapidly progressive necrotizing infection of the perineal and genital fascia, often polymicrobial. Severity is increased in older patients, diabetics and the immunocompromised. As in this case, the disease can have an indolent onset. Early recognition and aggressive treatment is important.

Introduction

A 48-year-old presented to the emergency department with a 4-week history of inflamed scrotum. The medical history was remarkable for diabetes and smoking. He was afebrile and the vital signs were stable. On examination, his scrotum was edematous and erythematous with well-delineated black necrotic areas (Fig.1). The lactate was within normal limits. The patient was given broad-spectrum antibiotics and IV fluids and referred to Urology urgently. He was taken to the theater for debridement by the Urology consultant. This patient survived to discharge with no adverse neurological outcome.

Figure 1.

Edematous and erythematous scrotum with well delineated black necrotic areas.

Fournier gangrene is a rapidly progressive necrotizing infection of the perineal and genital fascia, often polymicrobial. In most infections a cutaneous, urethral or rectal source is identified 1,2. The disease can affect women and children but is more common in males 1,2. Severity is increased in older patients, diabetics and the immunocompromised 1,2. As in this case, the disease can have an indolent onset.

Early recognition and aggressive treatment is important 1,2. Management options include resuscitative measures, broad-spectrum antibiotics, and surgical debridement 1,2. The evidence for use of hyperbaric oxygen remains controversial 1,3. Despite optimal appropriate treatment, the disease has a high mortality rate. The mortality rate has been reported as 16–24 percent 1,2.

Conflict of Interest

None declared.