CLINICAL CASES   

Giornale Italiano di Dermatologia e Venereologia 2005 February;140(1):63-8

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: English, Italian

Fournier’s gangrene. Case report and review of the literature

Rosina P., Fracasso I., Chieregato C.

Unit of Dermatology and Venereology Department of Biomedical and Surgical Sciences University of Verona, Verona, Italy

Fournier’s gangrene (FG) or acute gangrene of genitalia, better known as synergistic necrotizing fasciitis, is a rare infective pathology affecting first the genitalia and, in a second time, near anatomical structures (perineum, abdomen and perianal area). It is a highly lethal severe infection. Fournier’s gangrene classically appears suddenly in young healthy males and rapidly progresses to necrosis because of an obliterative endoarteritis caused by the spread of micro-organisms into the subcutaneous space. The causative bacterias, most probably are both aerobic and anaerobic acting in a synergistic action, such as Staphylococcus aureus, Streptococcus, Clostridium, Pseudo-monas, Escherichia coli, Enterobacter, Proteus, Klebsiella, and Bacteroides. The precipitating factors of Fournier’s gangrene are 2: local traumatism and local skin, urinary and, above all, intestinal infections. Predisposing factors are diabetes mellitus, immunocompromised state and other systemic conditions (alcoholism, renal failure, leukaemia). Treatment consists of broad-spectrum antibiotics, sometimes supported by systemic corticosteroids, and of immediate debridment of necrotic tissue. Nevertheless, Fournier’s gangrene remains a severe pathology with a mortality rate higher than 25%. Early diagnosis and multidisciplinary approach are the keys to a successful management of Fournier’s gangrene.