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      Fournier’s Gangrene and Intravenous Drug Abuse: an Unusual Case Report and Review of The Literature

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          Abstract

          Fournier’s gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes.

          In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia.

          Fournier’s gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature.

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          Fournier's gangrene: a review of 1726 cases.

          N Eke (2000)
          Although there is much consensus, certain controversies exist regarding the management of Fournier's gangrene. Publications in English on Fournier's gangrene from January 1950 to September 1999 were obtained through the Medline database and relevant reference lists in publications. It was possible to identify 1726 cases for study. Data extracted for review included country of reported cases, number of patients in each report and relevant clinical features. Fournier's gangrene occurs worldwide. However, its definition has generated considerable controversy as efforts are made to refine the original description in the light of increasingly understood aetiological factors. Attempts to classify the disease into primary and secondary forms have not been successful. The basic pathological process, necrotizing fasciitis, has been identified in the perineum of women and children, although the disease afflicts the male more often than the female. Most reported cases have occurred in the USA and Canada. The major sources of sepsis are the local skin, colon, anus and rectum, and the lower urinary tract. Colonic, anal and rectal sources carry the worst prognosis. Diabetes mellitus is important in aetiological terms. Rare causes include vasectomy and circumcision. Investigations are essential to define the cause of an episode but not for the diagnosis of the disease. Early aggressive treatment of Fournier's gangrene and underlying conditions is essential. Hyperbaric oxygen and honey are treatment modalities yet to be universally adopted. Risk of death, 16 per cent overall in this series, is related to the patient's condition at presentation. Controversies over the definition of Fournier's gangrene persist but these do not affect the treatment options. The diagnosis is made on clinical grounds. The occurrence of the disease in women is under-reported and may go unrecognized by some clinicians. Some treatment options, such as hyperbaric oxygenation and radical excision, remain controversial.
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            Fournier's gangrene and its emergency management.

            A. Thwaini (2006)
            Fournier's gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high.
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              Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality

              El Bachir Benjelloun, Tarik Souiki, Nadia Yakla … (2013)
              Introduction Fournier’s gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier’s gangrene and to identify risk factors that affect mortality. Methods The medical records of 50 patients with Fournier’s gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality. Results Ten males and five females were enrolled in the study. The mean age was 54 years (range 23–81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality. Conclusions Fournier’s gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Med (Wars)
                Journal ID (iso-abbrev): Open Med (Wars)
                Journal ID (publisher-id): med
                Journal ID (pmc): med
                Title: Open Medicine
                Publisher: De Gruyter
                ISSN (Electronic): 2391-5463
                Publication date (Electronic): 24 December 2019
                Publication date Collection: 2019
                Volume: 14
                Pages: 694-710
                Affiliations
                [1 ]Department of Surgical and Biomedical Sciences, University of Perugia , Perugia, Italy
                [2 ]Department of General Surgery and Surgical Specialties “Paride Stefanini”;, Sapienza University of Rome , Rome, Italy
                [3 ]Division of General Surgery, Department of Surgical and Biochemical Sciences, University of Perugia , Perugia, Italy
                Author notes
                Article
                Publisher ID: med-2019-0114
                DOI: 10.1515/med-2019-0114
                PMC ID: 6947763
                PubMed ID: 31934634
                SO-VID: ab180888-c83e-4623-badf-af34d0b804fa
                Copyright © © 2019 Michele Del Zingaro et al., published by De Gruyter
                License:

                This work is licensed under the Creative Commons Attribution 4.0 Public License.

                History
                Date received : 09 February 2019
                Date accepted : 09 July 2019
                Page count
                Pages: 17
                Categories
                Subject: Research Article

                Keywords: fournier's gangrene,necrotizing fasciitis,surgery,infection
                Data availability:
                Keywords: fournier's gangrene, necrotizing fasciitis, surgery, infection

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