Fournier’s Gangrene and Intravenous Drug Abuse

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.

Keywords: Fournier’s gangrene, Necrotizing Fasciitis, Surgery, Infection

Case report

A 52 year old man with a history of a cocaine use disorder, who was in methadone maintenance therapy and affected by HCV-related chronic liver disease, was admitted to the Emergency Department of a high-volume hospital. At admission to our institution, he presented with fever, acute renal impairment, anuria, poor hygienic conditions, and necrotic tissue involving the external genitalia (Figure 1). HIV testing was negative. The patient reported no other urological symptoms at hospital afdmission.

The patient underwent resuscitation intravenous fluid support; antibiotic therapy was administered with tigecycline and meropenem. A single, prompt, extended surgical debridement of external genital, perineal, perianal and infrapubic regions to healthy tissue was performed. The patient also underwent at the same time right orchiectomy.

The microbiologic culture of the wound specimen revealed Staphylococcus lugdunensis with tigecycline susceptibility. Urine and blood samples cultures were negative. Tigecycline and meropenem were administered until discharge.

The anuric condition persisted for 24 hours; then polyuria developed, but with a renal impairment that required treatment with dialysis.

Five days after the surgical debridement the patient reported the injection of cocaine into the superficial dorsal vein of the penis.

The physical examination was notable for necrotic-appearing tissue in the entire penis and scrotum, with areas of induration and crepitus

The histologic report confirmed an inflammatory necrotizing process of subcutaneous tissue that expanded to skin, testicular and epididymis parenchyma, rete testis and peritesticular tissue.

The patient was discharged 17 days after the surgical debridement and was admitted to the waiting list for a skin graft, which was successfully performed 1 month later.

Credits: Michele Del Zingaro, NCBI

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