Although the diagnosis is straightforward in the classic presentation, failure to examine the perineal area, especially in the older or obtunded patient, can result in misdiagnosis. Furthermore, the early symptoms of FG and NSTIs are not characteristic; hence, FG is often misdiagnosed as cellulitis or abscess in 75% of cases
Of all the diseases linked with itching, only kidney problems could explain the reported features of Herod's last days, said Prof Hirschmann. "I concluded that his chronic kidney disease was complicated by an unusual infection of the male genitalia called Fournier's gangrene."
One of the most feared and commonly fatal findings in the perineum.
Accumulation of more than 2 mm of subcutaneous fluid is the most accurate diagnostic criteria on USto differentiate between NSTI and cellulitis.
Although the diagnosis of FG is clinical, this disease can sometimes difficult to diagnose, especially early in its presentation. For this reason patients with FG typically have a delayed diagnosis with several misidentifications such as simple cellulitis, pyoderma gangrenosum or hidradenitis suppurativa. POCUS might be a quick and early tool to confirm suspicion of subcutaneous air.
There is no set of clinical findings, lab test results and even imaging that can definitively rule out necrotizing fasciitis – an infection of the deep soft tissues that rapidly spreads along fascial planes and carries a mortality of 30-40%, even with therapy.
Fournier’s gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing fasciitis of the external genitalia. Mainly associated with men and those over the age of 50, Fournier’s gangrene has been shown to have a predilection for patients with diabetes as well as people who are long-term alcohol misusers.
There are few urologic emergencies that are more important to quickly recognize than Fournier’s gangrene. A necrotizing infection of the perineum, Fournier’s is usually caused by a polymicrobial infection. The condition is life-threatening with a mortality rate up to 22% despite aggressive therapy.
Fournier's gangrene was first described by Baurienne in 1764 as a rapidly progressive soft tissue infection of the male perineum of unknown etiology. Jean-Alfred Fournier (1860–1902), a French venerologist, is credited with identifying the disease. He lectured and wrote about it, which he had seen in previously healthy men. While initially the etiology was unknown and it was thought to be a disease of young men, a cause is now found in the majority of cases, and it can be present at any age in both sexes.
Early recognition and high clinical suspicion are important in making a timely diagnosis, as early manifestations are often subtle.
In FG, suppurative bacterial infection results in microthrombosis of the small subcutaneous vessels leading to the development of gangrene of the overlying skin.
"May lead to a flesh-eating genital infection." Now that's a warning that may get some attention during a drug commercial.
The U.S. Food and Drug Administration (FDA) issued a warning about a rare but highly disconcerting condition that may occur with the use of a class of type 2 diabetes medications called sodium-glucose cotransporter-2 (SGLT2) inhibitors.
This meta-analysis demonstrates that diagnosis of necrotizing fasciitis is difficult and the tools we have as Emergency Physicians do not have the best diagnostic accuracy to be able to rule out necrotizing fasciitis on their own given low sensitivities. CT scan looking for fascial edema or enhancement or gas appears to have the highest sensitivity of 94.3%. However, there is still room for error and a negative CT scan does not definitively exclude necrotizing fasciitis.
Necrotizing fasciitis is a rapidly progressive bacterial infection that tracks along the fascia and is associated with severe sepsis and a deadly prognosis. The diagnosis is rare compared to cellulitis and abscesses, though it may initially present very similarly, making recognition a challenge.
Necrotizing fasciitis (NF) is a rare but deadly infection that is a surgical emergency. Unfortunately, due to the rarity of the disease as well as the fact that diagnosis is made in the operative theater, delay in diagnosis is common.
The treatment mantra remains as previously: prompt, radical surgical debridement with antibiotic broad-spectrum therapy in an intensive care environment. Surgical intervention should take place within the first 24 hours, since this significantly increases the chances of survival.
Pain is generally the most useful finding...
Necrotizing fasciitis remains a clinical diagnosis, but early in the course of illness, the clinical findings can be subtle. Bedside evidence of soft tissue gas can elevate the urgency of specialist consultation and time to diagnosis.
Symptoms include fever, general discomfort (malaise), moderate to severe pain and swelling in the genital and anal areas (perineal) followed by rankness and smell of the affected tissues (fetid suppuration) leading to full blown (fulminating) gangrene.
Fournier gangrene is a fulminant, spreading necrotizing infection of the skin and subcutaneous tissue of the scrotum, genitalia and/or perineum, which was first reported by Fournier in 1883.
Fournier gangrene is a rapidly progressive, life-threatening infectious process that involves the genital and perineal areas. The disease is one of the few urological emergencies and requires prompt surgical debridement as well as antibiotic therapy.