Fatal infections in andrology. Atypical clinical presentation of a Fournier’s disease


Submitted: December 29, 2019
Accepted: March 27, 2020
Published: October 2, 2020
Abstract Views: 813
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Authors

  • Valerio Olivieri Division of Urology, Ivrea civil Hospital (ASL TO4), Ivrea (Turin), Italy.
  • Gabriele Ruggiero Division of Urology, Ivrea civil Hospital (ASL TO4), Ivrea (Turin); Division of Urology, Ciriè Hospital (ASLTO4), Ciriè (Turin), Italy.
  • Danilo Abate Division of Urology, Ciriè Hospital (ASLTO4), Ciriè (Turin), Italy.
  • Nicoletta Serra Division of Urology, Ciriè Hospital (ASLTO4), Ciriè (Turin), Italy.
  • Valentina Fortunati Division of Pathology, Hospital “Policlinico of Tor Vergata”, Rome, Italy.
  • Daniele Griffa Division of Urology, Ivrea civil Hospital (ASL TO4), Ivrea (Turin); Division of Urology, Ciriè Hospital (ASLTO4), Ciriè (Turin), Italy.
  • Flavio Forte Division of Urology, Hospital “Madre Giuseppina Vannini”, Rome, Italy.
  • Emanuele Corongiu Division of Urology, Hospital “Madre Giuseppina Vannini”, Rome, Italy.

Background: Fournier disease (FD) is a worrisome infection of genital area caused by a polimicrobial infection and characterized by a rapid progression to necrosis. Scrotum, perineum and lower abdomen represent the primary sites of origin. Clinical presentation and laboratory strongly suggest FD, but if not precociously diagnosed, it may quickly evolve into septic syndrome and patient’s death.
Case report: A 62 years old Caucasian male presented for fever and penile gross oedema recently occurred. No history of previous urinary tract infection, hematuria or genital trauma was referred. He did not complain any storage or voiding low urinary tract symptom (LUTS); no foci of infection in genitoperineal area was observed nor urethral discharge. The ultrasound (US) revealed a disomogeneous broad thickening of subcutaneous tissues with increased vascularity on Color-Doppler. When the penis was manipulated in order to reduce oedema, retract foreskin and evaluate the glans, clinical parametres rapidly worsened and the patient developed a septic shock with blood pressure falling down, dyspnoea and tachyarrhythmia, and he was fastly sent to Intensive Care Unit where it has been hemodynamically stabilized and subjected to antibiotic therapy. Considering the clinical absence of gangrene’s foci, we opted for a conservative treatment by maintaining bladder catheter and drug therapy.


Akbulut F, Kucuktopcu O, Sonmezay E, Simsek A, Ozgor F, Gurbuz ZG. Partial penectomy after debridement of a Fournier’s gangrene progressing with an isolated penile necrosis. Ulus Trav Acil Cerrahi Derg. 2014 sept;20(05):358-8 DOI: https://doi.org/10.5505/tjtes.2014.93636

Al-Ali BM, Popper H, Pummer K. A case of Fournier's gangrene after hydrocelectomy. Cent European J Urol. 2012;65(2):92-3 DOI: https://doi.org/10.5173/ceju.2012.02.art9

Ameh EA, Dauda MM, Sabiu L, Mshelbwala PM, Mbibu HN, Nmadu PT. Fournier's gangrene in neonates and infants. Eur J Pediatr Surg. 2004 Dec;14(6):418-21 DOI: https://doi.org/10.1055/s-2004-821138

Anchi T, Tamura K, Inoue K, Ashida S, Yasuda M, Kataoka S. Localized Fournier’s gangrene of the penis: A case report. Hinyokika Kiyo 2009;55

Ashutosh T., Neerja P., Majhail S. J Cutan Aesthet Surg. 2010 Jan-Apr;3(1):41-44 DOI: https://doi.org/10.4103/0974-2077.63394

Avery LL, Scheinfeld MH. Imaging of penile and scrotal emergencies.Radiographics. 2013 May;33(3):721-40 DOI: https://doi.org/10.1148/rg.333125158

Avinash Chennamsetty, Iyad Khourdaji, Frank Burks and Kim A. Killinge. Contemporary diagnosis and management of Fournier’s gangrene. Ther Adv Urol 2015, Vol. 7(4) 203 –215 DOI: https://doi.org/10.1177/1756287215584740

Bjurlin MA, O'Grady T, Kim DY, Divakaruni N, Drago A, Blumetti J, Hollowell CM. Causative pathogens, antibiotic sensitivity, resistance patterns, and severity in a contemporary series of Fournier's gangrene. Urology. 2013 Apr;81(4):752-8 DOI: https://doi.org/10.1016/j.urology.2012.12.041

Bolesław Kuzaka B, Marta M. Wróblewska MM,Tomasz Borkowski T, Dariusz Kawecki D, Piotr Kuzaka P,Grażyna Młynarczyk G, Radziszewski P. Fournier’s Gangrene: Clinical Presentation of 13 Cases. Med Sci Monit. 2018; 24: 548–555. DOI: https://doi.org/10.12659/MSM.905836

Bruketa T, Majerovic M, Augustin G. Rectal cancer and Fournier's gangrene - current knowledge and therapeutic options.World J Gastroenterol. 2015 Aug 14;21(30):9002-20 DOI: https://doi.org/10.3748/wjg.v21.i30.9002

Chawla, S., Gallop, C. and Mydlo, J. Fournier’s gangrene: an analysis of repeated surgical debridement. Eur Urol 43: 572–575. - 2003 DOI: https://doi.org/10.1016/S0302-2838(03)00102-7

Chen S., Fu, J., Wang, C., Lee, T. Fournier gangrene: a review of 41 patients and strategies for reconstruction. Ann Plast Surg 64: 765–769 – 2010 DOI: https://doi.org/10.1097/SAP.0b013e3181ba5485

Chia L, Crum-Cianflone NF. Emergence of multi-drug resistant organisms (MDROs) causing Fournier's gangrene. J Infect. 2018 Jan;76(1):38-43. DOI: https://doi.org/10.1016/j.jinf.2017.09.015

Comploj E, Pycha A. Plastic reconstruction of external genitalia after Fournier's gangrene. Urologe A 2017 Oct;56(10):1289-1292. DOI: https://doi.org/10.1007/s00120-017-0477-2

Czymek, R., Schmidt, A., Eckmann, C., Bouchard, R., Wulff, B. and Laubert, T. Fournier’s gangrene: vacuum-assisted closure versus conventional dressings. 2009 Am J Sur 197: 168–176 DOI: https://doi.org/10.1016/j.amjsurg.2008.07.053

Deb PP, Choudhary A, Dey RK, Das RK. Isolated Involvement of Penis in Fournier's Gangrene: A Rare Possibility. J Coll Physicians Surg Pak. 2018 Feb;28(2):164-165 DOI: https://doi.org/10.29271/jcpsp.2018.02.164

Ekingen G, Isken T, Agir H, Oncel S, Günlemez A. Fournier's gangrene in childhood: a report of 3 infant patients. J Pediatr Surg. 2008 Dec;43(12):e39-42 DOI: https://doi.org/10.1016/j.jpedsurg.2008.09.014

Faraklas I, Stoddard GJ, Neumayer LA, Cochran A. Development and validation of a necrotizing soft-tissue infection mortality risk calculator using NSQIP.J Am Coll Surg. 2013 Jul;217(1):153-160.e3; discussion 160-1 DOI: https://doi.org/10.1016/j.jamcollsurg.2013.02.029

Geraci G, Pisello F, Lupo F, Cajozzo M, Sciumè C and Modica G, Fournier’s gangrene: case report and review of recent literature. Ann Ital Chir. 2004 Jan-Feb; 75(1);97-106

Lauerman MH1, Kolesnik O, Sethuraman K, Rabinowitz R, Joshi M, Clark E, Stein D, Scalea T, Henry S.Less is more? Antibiotic duration and outcomes in Fournier's gangrene. J Trauma Acute Care Surg. 2017 Sep;83(3):443-448. DOI: https://doi.org/10.1097/TA.0000000000001562

Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier’s gangrene. J Urol. 1995;154:89-92 DOI: https://doi.org/10.1016/S0022-5347(01)67236-7

Levett DZ, Bennett MH, Millar I. Adjunctive hyperbaricoxygen for necrotizing fascitis. Cochrane Database Syst Rev. 2015 Jan; 2015 DOI: https://doi.org/10.1002/14651858.CD007937.pub2

Lin WT, Chao CM, Lin HL, Hung MC, Lai CC. Emergence of antibiotic-resistant bacteria in patients with Fournier gangrene. Surg Infect (Larchmt). 2015 Apr;16(2):165-8 DOI: https://doi.org/10.1089/sur.2013.118

Milanese G, Quaresima L, Dellabella M, Scalise A, Di Benedetto GM, Muzzonigro G, Minardi D. A conservative approach to perineal Fournier's gangrene. Arch Ital Urol Androl. 2015 Mar 31;87(1):28-32 DOI: https://doi.org/10.4081/aiua.2015.1.28

Misiakos E, Bagias G, Sotiropoulos PPD, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fascitis. Frontiers in surgery. 2014 Sept.; vol. 1; Art. 36 DOI: https://doi.org/10.3389/fsurg.2014.00036

Moslemi MK, Sadighi Gilani MA, Moslemi AA, Arabshahi A. Fournier gangrene presenting in a patient with undiagnosed rectal adenocarcinoma: a case report.Cases J. 2009 Dec 3;2:9136 DOI: https://doi.org/10.1186/1757-1626-2-9136

Muharremi S. Fournier’s disease gangrene, a rare complication of diabetes mellitus (case report). Georgian Med News. 2018 Apr;(277):57-60.

Obi AO. Isolated Fournier's gangrene of the penis. Niger J Clin Pract. 2016 May-Jun;19(3):426-30 DOI: https://doi.org/10.4103/1119-3077.179297

Ossibi PE, Souiki T, Ibn Majdoub K, Toughrai I, Laalim SA, Mazaz K, Tenkorang S, Farih MH. Fournier gangrene: rare complication of rectal cancer. Pan Afr Med J. 2015 Mar 24;20:288 DOI: https://doi.org/10.11604/pamj.2015.20.288.5506

Parker RA, Menias CO, Quazi R, Hara AK, Verma S, Shaaban A, Siegel CL, Radmanesh A, Sandrasegaran K. MR Imaging of the Penis and Scrotum. Radiographics. 2015 Jul-Aug; 35(4): 1033-50. DOI: https://doi.org/10.1148/rg.2015140161

Piszczek J, Dalton B, Peters T, Ruether D, Urbanski S. Extensive necrotizing fasciitis associated with sunitinib therapy.Clin Genitourin Cancer. 2014 Apr;12(2):e47-9 DOI: https://doi.org/10.1016/j.clgc.2013.11.017

Polistena A, Cavallaro G, D'Ermo G, Avenia N, De Toma G. Fournier's gangrene: early diagnosis. How to diagnose, how to manage it. Minerva Chir. 2014 Apr;69(2):113-9.

Ramazan Topaktaş, Selçuk Altın, Cemil Aydın, Ali Akkoç, Yakup Yılmaz. Retrospective evaluation of urological admissions to emergency service of a training and research hospital. Turkish Journal of Urology 2014; 40(4): 216-20 DOI: https://doi.org/10.5152/tud.2014.77861

Romics I. Fournier’s gangrene. Orv Hetil. 2009 mar 22; 150(12):549-53 DOI: https://doi.org/10.1556/oh.2009.28575

Serhan Cimen. Evaluation of urologic emergency cases applying to emergency service. Arch Clin Exp Surg.2019;8:1-6 DOI: https://doi.org/10.5455/aces.20180417061736

Skeldon SC, Goldenberg SL. Urological complications of illicit drug use. NatRevUrol. 2014 Mar;11(3):169-77 DOI: https://doi.org/10.1038/nrurol.2014.22

Temiz MZ, Yuruk E, Aykan S, Tuken M, Kandirali E. Isolated Penile Fournier's Gangrene Presenting with glans penis Involvement. J Coll Physicians Surg Pak. 2015 Oct;25 Suppl 2:S140-1

Tenório CEL , Correia Lima SV, Vasconcelos de Albuquerque A, Pauferro Cavalcanti M , Teles F. Risk factors for mortality in fournier’s gangrene in a general hospital use of simplified founier gangrene severe index score (SFGSI). Int Braz. J. Urol. 2018 DOI: https://doi.org/10.1590/s1677-5538.ibju.2017.0193

Ueshima J, Maeda K, Wakabayashi H, Nishioka S, Nara S, Nakatani H. Availability of Early, Intensive, and Continuous Nutrition Management for Fournier's Gangrene with Rectal Cancer: A Case Report. J Acad Nutr Diet. 2016 Jun;116(6):909-16 DOI: https://doi.org/10.1016/j.jand.2015.09.021

Varada NL, Sakoulas G, Lei LR, Chua J. Agranulocytosis with ceftaroline high-dose monotherapy or combination therapy with clindamycin. Pharmacotherapy. 2015 Jun;35(6):608-12 DOI: https://doi.org/10.1002/phar.1596

Wong, C., Khin, L., Heng, K., Tan, K. and Low, C. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. 2004. Crit Care Med 32: 1535–1541 DOI: https://doi.org/10.1097/01.CCM.0000129486.35458.7D

Wysoki, M., Santora, T., Shah, R., Friedman. A Necrotizing fascitis: CT characteristics. Radiology 1997, 203: 859–863 DOI: https://doi.org/10.1148/radiology.203.3.9169717

Yanaral F1, Balci C, Ozgor F, Simsek A, Onuk O, Aydin M, Nuhoglu B. Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier's gangrene. Arch Ital Urol Androl. 2017 Oct 3;89(3):208-211 DOI: https://doi.org/10.4081/aiua.2017.3.208

Yecies T, Lee DJ, Sorbellini M, Ramasamy R. Penile Fournier’s gangrene. Urology. 2013 Oct;82(4):e3 DOI: https://doi.org/10.1016/j.urology.2013.07.025

Zagli G, Cianchi G, Degl'Innocenti S, Parodo J, Bonetti L, Prosperi P, Peris A. Treatment of Fournier's Gangrene with Combination of Vacuum-Assisted Closure Therapy, Hyperbaric Oxygen Therapy, and Protective Colostomy. Case Rep Anesthesiol. 2011; 430983 DOI: https://doi.org/10.1155/2011/430983

Olivieri, V., Ruggiero, G., Abate, D., Serra, N., Fortunati, V., Griffa, D., Forte, F., & Corongiu, E. (2020). Fatal infections in andrology. Atypical clinical presentation of a Fournier’s disease. Archivio Italiano Di Urologia E Andrologia, 92(3). https://doi.org/10.4081/aiua.2020.3.213

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