A 35-year-old man presented at our hospital with high fever (up to 39.7 °C), and progressive
edema and pain of the scrotal and perineal region for 7 days. He had received intravenous
levofloxacin at local hospital since 2 days after onset of the symptoms. He has a
history of unwell-controlled diabetes mellitus for the last 2 years. Clinical examination
revealed a mousy odor, swelling, exudation and necrosis of the penis and scrotum (Fig. 1). The leukocyte count was 16.2 × 109/L, and neutrophil was 15.4 × 109/L (94.8%). Enterococcus faecalis and Klebsiella pneumoniae grew from the cultures of exudation and necrotizing tissues. Blood culture grewed
K. pneumoniae and Escherichia coli. A plenty of Gram negative bacteria were found in the exudation. Fournier's gangrene
was diagnosed. Broad spectrum antibiotics were given, and adequate debridement with
excision of all necrotic tissue was done. The patient received a surgical debridement
and he was stable without fever after the surgery.
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References
- Fournier’s gangrene mortality; a 17-year systematic review and meta-analysis.Int J Infect Dis. 2020; 92: 218-225https://doi.org/10.1016/j.ijid.2019.12.030
- Beware of perianal pain: Fournier's gangrene.Am J Med. 2020; ([Epub ahead of print])https://doi.org/10.1016/j.amjmed.2019.11.028
- Fournier gangrene associated with sodium-glucose cotransporter-2 inhibitors: a review of spontaneous postmarketing cases.Ann Int Med. 2019; 170: 764-769
Article info
Publication history
Published online: February 27, 2020
Accepted:
February 15,
2020
Received:
February 7,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
