Fournier's gangrene with retroperitoneal extension, a case report

BACKGROUND: Fournier's gangrene (FG) is a polymicrobial, both aerobic and anaerobic, synergistic necrotizing fasciitis of the perineal, genital, or perianal regions. It is a rapidly progressive and fulminant soft tissue infection and it is potentially fatal. Fournier's gangrene has been shown to be strongly associated with diabetes, chronic alcoholism, human immunodeficiency virus (HIV), lymphoproliferative diseases, chronic steroid abuse, and cytotoxic drugs. CLINICAL PRESENTATION: A 25-year-old Ethiopian male patient with no previous medical history presented to the emergency department with a four-day history of perineal pain, swelling, and discharge. Associated with this he had a high-grade fever and one episode of vomiting of ingested matter. On examination, he was febrile, tachycardic, and hypotensive. He had a grossly necrotic scrotum and palpable crepitus extending to the left lower anterior abdominal wall. CLINICAL DISCUSSION: On investigations, he had elevated leukocyte count, random blood sugar, low hemoglobin, and elevated creatinine levels. Subsequently, the patient was admitted and was started with broad-spectrum antibiotics and multiple debridements were done along with other supportive measures. Finally, the patient was discharged improved after 17 days of hospital stay. CONCLUSION: Fournier's gangrene is a rapidly progressive, fulminant infection. Nevertheless, prompt diagnosis can be difficult and requires a high index of suspicion. Early diagnosis and appropriate management have paramount importance in reducing mortality and morbidity in these patients.