Fournier gangrene

Background

• A necrotizing soft tissue infection that involves the scrotum and penis or the vulva
• The main risk factor is diabetes mellitus

Microbiology

• Mostly caused by mixed aerobic and anaerobic organisms
  • The mix can sometimes include Staphylococcus aureus and/or Pseudomonas aeruginosa
• Can be caused by monomicrobial Staphylococcus aureus infection as well

Pathophysiology

• Typically from contiguous spread from:
  • A perianal or retroperitoneal infection, or
  • A urinary tract infection, particularly with urethral stricture, or
  • Traumatic inoculation into the soft tissues

Clinical Manifestations

• Can be insidious or abrupt onset
• Symptoms include local pain, swelling, and erythema, as well as fevers
• Can progress to soft tissue necrosis and crepitus
• Can spread to perineum and anterior abdominal wall
• Typically spares the testes, glans, and spermatic cord