Diagnosis
A mixed synergistic necrotizing fasciitis in the perineum of diabetics.
Epidemiologic Risks
Diabetes, elderly, immunoincompetent, often there is no preceding trauma. It can occur in normal hosts, as in (Fournier's Gangrene due to Masturbation in an Otherwise Healthy Male). And you though blindness and hairy palms were bad.
Often starts as a perianal abscess.
Microbiology
Mixed/colonic flora: streptococci plus anaerobes plus coliforms.
Empiric Therapy
Surgery is the primary treatment, for antibiotics (third-generation cephalosporins PLUS metronidazole) OR carbapenems alone OR (quinolone PLUS metronidazole) OR penicillin/beta-lactamase inhibitors.
Pearls
Nothing heals like cold steel; it is a surgical disease first.
First described by Jean-Alfred Fournier in 1883 Gangrène foudroyant de la verge (overwhelming gangrene). I remember walking by the Place du Docteur-Alfred-Fournier when in Paris (PubMed).
According to Wikipedia, "The most historically prominent sufferers from this condition may have been Herod the Great, his grandson Herod Agrippa, and possibly the Roman emperor Galerius."
What infects humans, crocodiles and dolphins?
Last Update: 07/22/18.