Fournier gangrene
Variant: Fournier disease
(for-nē'ā 
)
[Jean Alfred Fournier, Fr. dermatologist, 1832–1915]
Infectious, necrotizing fasciitis of the genitals. It may spread to the thighs or abdomen. This aggressive and life-threatening form of cellulitis typically occurs in patients who have had local trauma to the perineum and in patients with diabetes mellitus.
Etiology: Fournier gangrene is a polymicrobial cellulitis typically occurring in patients who have had local trauma to the perineum, in patients who have diabetes mellitus, in alcoholics, or in patients who have cancer or are immunosuppressed. Infectious organisms identified by culture typically include both anaerobes and Enterobacteriaceae.
Symptoms and Signs: After surgery or minor trauma to the inguinal region, or after a breach between the GI tract and the perineum, patients develop intense pain, swelling, and redness of the surrounding skin and fascia (underlying soft tissues), often with a putrid odor. The skin and soft tissues may change color (becoming purple, splotchy or blue-black). As infection spreads along fascial planes, patients may become systemically ill, with fevers, sweats, prostration, malaise, muscle pain, or altered mental status.
Diagnosis: The appearance of the rash is suggestive of the disease. Palpable crepitus of the affected tissues is sufficient evidence to request a surgical consultation. Blood tests often reveal an elevation in creatine kinase (a muscle enzyme) as the infection spreads along muscle fascial planes.
Treatment: Surgical débridement of the infection is crucial to prevent its spread.
Impact on Health: Mortality due to Fournier gangrene is approx. 30%. Patients who survive frequently undergo many surgical procedures to control the spread of the infection and to have damaged tissues reconstructed.
Patient Care: Prompt exploration and débridement of the wound are the cornerstones of patient care, along with the administration of analgesics, fluids, broad-spectrum antibiotics, and intensive patient observation.
SEE: necrotizing fasciitis.