Fournier's gangrene

Etiology

• polymicrobial infection
  • Staphylococcus aureus
  • Streptococcus sp.
  • Klebsiella sp.
  • Escherichia coli
  • anaerobic bacteria
    • involvement of Clostridium sp. less common
• risk factors include
  • immunodeficiency
  • diabetes mellitus
    • SGLT2 inhibitors (flozins)
  • malnutrition
  • recent history of urinary catheterization or instrumentation
  • perineal surgery

Epidemiology

• rare
• incidence is increasing with an ageing population

Pathology

• typically a type 1 necrotizing fasciitis
  • involvement can include perineum, scrotum, penis, anterior abdominal wall
• endotoxins cause tissue necrosis & severe cardiovascular impairment
• subsequent inflammatory reaction by the host contributes to multi-organ failure
• degree of internal necrosis is much greater than suggested by external signs

Clinical manifestations

• painful swelling & erythema of the scrotum or perineum
  • testicular pain, perianal pain
• signs of severe sepsis
• small necrotic bulla with surrounding erythema & edema
• crepitus on palpation & a foul-smelling exudate (prululent drainage) occurs with more advanced disease
• in up to 40% of cases, the onset is insidious with undiagnosed pain

Management

• broad spectrum intravenous antibiotics
  • coverage for gram-positive, gram-negative & anaerobic bacteria
• adequate, repeated surgical debridement is necessary to save life
• following resolution, reconstruction using skin grafts is required

prognosis:

• with aggressive early surgical management, survival rates may be >70%

More general terms

• gangrene
• fasciitis
• urogenital disease