Fournier's Gangrene Masking as Perineal and Scrotal Cellulitis

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Abstract

Fournier's gangrene (FG) is a very serious and life threatening emergency. FG is a polymicrobial subset of necrotizing fasciitis affecting the genital region. Most cases have a perianal or colorectal focus; less often the gangrene originates from the urogenital tract or is preceded by trauma or a surgical procedure. FG is a surgical emergency that requires early intervention. Therefore, early recognition by emergency physicians is imperative. The diagnosis of FG during its early stages is often challenging and misdiagnosis is common. If FG is suspected, emergency department management should always include antimicrobial treatment with parenteral broad-spectrum antibiotics, aggressive hemodynamic stabilization and surgical consultation. We report a case of FG in an elderly male with no major risk factors, who presented with right groin and perineal pain that was initially diagnosed as scrotal cellulitis. He was later diagnosed with FG and subsequently developed multi-organ failure, required multiple surgical debridements, and was later transferred to a long-term care facility with poor prognosis.

This case is important because it calls attention to the challenges of diagnosing this potentially fatal disease. Emergency physicians must recognize the symptoms of FG because early diagnosis can improve outcomes.

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