A patient with Type 2 Diabetes Mellitus (T2DM) with Fournier gangrene: a case report

Mike Christanti; Jongky Hendro Prajitno; Rio Yudistira Christanto

doi:10.15562/bmj.v11i1.2957

A patient with Type 2 Diabetes Mellitus (T2DM) with Fournier gangrene: a case report

Mike Christanti ,

Jongky Hendro Prajitno ,

Rio Yudistira Christanto ,

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DOI: https://doi.org/10.15562/bmj.v11i1.2957 |
Published: 2022-02-18

Abstract

Background: Fournier gangrene is necrotizing fasciitis of the genitalia and perineum that can extend to the abdominal wall, gluteus or lower extremities. Predisposing factors for Fournier gangrene include obesity, diabetes mellitus (DM), alcoholism, smoking, hypertension, chronic kidney disease, perianal trauma and immunosuppressive conditions. This case report aims to evaluate the management of Fournier gangrene on metabolic and surgical treatment

Case Presentation: A-53 years old-female with Type 2 Diabetes Mellitus (T2DM) came to the Emergency Ward of Dr. Sutomo General Hospital, Surabaya, with the chief complaint of sores on the buttocks for 1 week. The patient was diagnosed with Fournier gangrene. On physical examination in the room, erythematous macular lesions were found in the folds of the breast and armpit on chest examination. Obtained scratch marks were found because the patient is often scratched. The wound from the buttock and keep enlarged due to the Fournier gangrene ( necrotizing infection). In this case, the patient was given the antibiotics ceftriaxone and metronidazole. The patient died during the 8^th day of treatment due to a suspected septic shock.

Conclusion: Surgical management in this patient is debridement. Multi-disciplinary management of obstetrics, urology, digestive surgery, and plastic surgery is required for the management of Fournier gangrene in T2DM patients

References

Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Ushakov AA, Beresneva TA, et al. Fournier's Gangrene: Literature Review and Clinical Cases. Urol Int. 2018;101(1):91-97.
El-Shazly M, Aziz M, Aboutaleb H, Salem S, El-Sherif E, Selim M, et al. Management of equivocal (early) Fournier's gangrene. Ther Adv Urol. 2016;8(5):297-301.
Chen Y, Wang X, Lin G, Xiao R. Successful treatment following early recognition of a case of Fournier's scrotal gangrene after a perianal abscess debridement: a case report. J Med Case Rep. 2018;12(1):193.
Li J, Chen J, Kirsner R. Pathophysiology of acute wound healing. Clin Dermatol. 2007;25(1):9-18.
Majdoub W, Mosbahi A, Bonbled F. Sudden unexpected death due to Fournier gangrene. Forensic Sci Med Pathol. 2019;15(1):155-158.
Y?lmazlar T, I??k Ö, Öztürk E, Özer A, Gülcü B, Ercan ?. Fournier's gangrene: review of 120 patients and predictors of mortality. Ulus Travma Acil Cerrahi Derg. 2014;20(5):333-337.
Eke N. Fournier's gangrene: a review of 1726 cases. Br J Surg. 2000;87(6):718-728.
Tang LM, Su YJ, Lai YC. The evaluation of microbiology and prognosis of fournier's gangrene in past five years. Springerplus. 2015;4(1):14.
Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014;1:36.
Ballard DH, Mazaheri P, Raptis CA, Lubner MG, Menias CO, Pickhardt PJ, et al. Fournier Gangrene in Men and Women: Appearance on CT, Ultrasound, and MRI and What the Surgeon Wants to Know. Can Assoc Radiol J. 2020;71(1):30-39.
Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, et al. Fournier's gangrene and its emergency management. Postgrad Med J. 2006;82(970):516-519.
Wagner S, Greco F, Hoda MR, Kawan F, Heynemann H, Fornara P. Is intensive multimodality therapy the best treatment for fournier gangrene? Evaluation of clinical outcome and survival rate of 41 patients. Surg Infect (Larchmt). 2011;12(5):379-383.
Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier's gangrene. Ther Adv Urol. 2015;7(4):203-215.
Lin E, Yang S, Chiu AW, Chow YC, Chen M, Lin WC, et al. Is Fournier's gangrene severity index useful for predicting outcome of Fournier's gangrene? Urol Int. 2005;75(2):119-122.
Corcoran AT, Smaldone MC, Gibbons EP, Walsh TJ, Davies BJ. Validation of the Fournier's gangrene severity index in a large contemporary series. J Urol. 2008;180(3):944-948.
Taken K, Oncu MR, Ergun M, Eryilmaz R, Demir CY, Demir M, et al. Fournier's gangrene: Causes, presentation and survival of sixty-five patients. Pak J Med Sci. 2016;32(3):746-750.

[1] Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Ushakov AA, Beresneva TA, et al. Fournier's Gangrene: Literature Review and Clinical Cases. Urol Int. 2018;101(1):91-97.

[2] El-Shazly M, Aziz M, Aboutaleb H, Salem S, El-Sherif E, Selim M, et al. Management of equivocal (early) Fournier's gangrene. Ther Adv Urol. 2016;8(5):297-301.

[3] Chen Y, Wang X, Lin G, Xiao R. Successful treatment following early recognition of a case of Fournier's scrotal gangrene after a perianal abscess debridement: a case report. J Med Case Rep. 2018;12(1):193.

[4] Li J, Chen J, Kirsner R. Pathophysiology of acute wound healing. Clin Dermatol. 2007;25(1):9-18.

[5] Majdoub W, Mosbahi A, Bonbled F. Sudden unexpected death due to Fournier gangrene. Forensic Sci Med Pathol. 2019;15(1):155-158.

[6] Y?lmazlar T, I??k Ö, Öztürk E, Özer A, Gülcü B, Ercan ?. Fournier's gangrene: review of 120 patients and predictors of mortality. Ulus Travma Acil Cerrahi Derg. 2014;20(5):333-337.

[7] Eke N. Fournier's gangrene: a review of 1726 cases. Br J Surg. 2000;87(6):718-728.

[8] Tang LM, Su YJ, Lai YC. The evaluation of microbiology and prognosis of fournier's gangrene in past five years. Springerplus. 2015;4(1):14.

[9] Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014;1:36.

[10] Ballard DH, Mazaheri P, Raptis CA, Lubner MG, Menias CO, Pickhardt PJ, et al. Fournier Gangrene in Men and Women: Appearance on CT, Ultrasound, and MRI and What the Surgeon Wants to Know. Can Assoc Radiol J. 2020;71(1):30-39.

[11] Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, et al. Fournier's gangrene and its emergency management. Postgrad Med J. 2006;82(970):516-519.

[12] Wagner S, Greco F, Hoda MR, Kawan F, Heynemann H, Fornara P. Is intensive multimodality therapy the best treatment for fournier gangrene? Evaluation of clinical outcome and survival rate of 41 patients. Surg Infect (Larchmt). 2011;12(5):379-383.

[13] Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier's gangrene. Ther Adv Urol. 2015;7(4):203-215.

[14] Lin E, Yang S, Chiu AW, Chow YC, Chen M, Lin WC, et al. Is Fournier's gangrene severity index useful for predicting outcome of Fournier's gangrene? Urol Int. 2005;75(2):119-122.

[15] Corcoran AT, Smaldone MC, Gibbons EP, Walsh TJ, Davies BJ. Validation of the Fournier's gangrene severity index in a large contemporary series. J Urol. 2008;180(3):944-948.

[16] Taken K, Oncu MR, Ergun M, Eryilmaz R, Demir CY, Demir M, et al. Fournier's gangrene: Causes, presentation and survival of sixty-five patients. Pak J Med Sci. 2016;32(3):746-750.

A patient with Type 2 Diabetes Mellitus (T2DM) with Fournier gangrene: a case report

Abstract

References

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