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Rotting Away: Fournier's Gangrene

Although the diagnosis is frequently obtained clinically, CT or MRI of the infected area can provide confirmation by showing the appearance of free air in the subcutaneous tissues. When needed, these imaging studies can help to guide management, but imaging should never delay the necessary treatment – surgical debridement.

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  Brown Sound: Necrotizing Soft Tissue Infection

Accumulation of more than 2 mm of subcutaneous fluid is the most accurate diagnostic criteria on USto differentiate between NSTI and cellulitis.

Articles of Interest

A case of Fournier’s gangrene diagnosed with POCUS

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.

BCE 69 Necrotizing Fasciitis

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.

Contemporary diagnosis and management of Fournier’s gangrene

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.

Diagnose on Sight: Painful Scrotal Swelling

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.

Diagnosis: Fournier's Gangrene

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.

Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives

Early recognition and high clinical suspicion are important in making a timely diagnosis, as early manifestations are often subtle.

Fournier's gangrene and its emergency management

In FG, suppurative bacterial infection results in microthrombosis of the small subcutaneous vessels leading to the development of gangrene of the overlying skin.

Fournier’s Gangrene: ED presentations, evaluation, and management

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

How One Class Of Diabetes Medications May Lead To Flesh-Eating Genital Infections

"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.

Most privy gangrene helped to kill Herod

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."

Nec-Fasc Fast

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 and the Spectrum of Soft Tissue Infections

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: What We Have Learned

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.

Resources

EMCrit Project

Pain is generally the most useful finding...

Emory School of Medicine

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.

NORD

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.

ScienceDirest

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.

StatPearls

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.