Fournier gangrene
Fournier gangrene is a type of necrotizing fasciitis or gangrene affecting the external genitalia or perineum. It most commonly occurs in older men, but it can also occur both in women and children, diabetics, alcoholics, or the immunocompromised.
Epidemiology and history
About one per 62,500 males are affected per year. Males are affected about 40 times more often than females. It was first described by Baurienne in 1764 and is named after a French venereologist, Jean Alfred Fournier, following five cases he presented in clinical lectures in 1883.Signs and symptoms
Initial symptoms of Fournier gangrene include swelling or sudden pain in the scrotum, fever, pallor, and generalized weakness. It is characterized by pain that extends beyond the border of the demarcated erythema. Most cases present mildly, but can progress in hours. Subcutaneous air is often one of the specific clinical signs, but is not seen in >50% of presenting clinical cases. More marked cases are characterized by a foul odor and necrotic infected tissue. Crepitus has been reported. It begins as a subcutaneous infection. However, necrotic patches soon appear in the overlying skin, which later develop into necrosis.Cause
Most cases of Fournier gangrene are infected with both aerobic and anaerobic bacteria such as Clostridium perfringens. It can also result from infections caused by group A streptococcus, as well as other pathogens such as Staphylococcus aureus and Vibrio vulnificus. Lack of access to sanitation, medical care, and psychosocial resources has been linked to increased mortality.A 2006 Turkish study reported that blood sugar levels were elevated in 46 percent of patients diagnosed with Fourniers. Another study reported that about one third of patients were alcoholic, diabetic, and malnourished, while another ten percent had been immunosuppressed through chemotherapy, steroids, or malignancy.
Fournier gangrene is a rare side effect of SGLT2 inhibitors, which increase the excretion of glucose in the urine.