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29 January 2009

Fournier's gangrene: historical survey, current status, and case description

Ryszard ZabaABEG, Andrzej GrzybowskiDEF, Janusz ProkopEF, Zbigniew ZabaBC, Czeslaw ZabaBD

Med Sci Monit 2009; 15(2): CS34-39 :: ID: 869545

Abstract

Background
The first-documented clinical picture of the disease was made by Fournier in 1883. Its epidemiology has changed and is much different from the original. It is infectious in its etiology, affecting mostly men between 50 and 60 years of age. Predisposing factors include diabetes, neoplasms, chronic glucocorticoid therapy, immune-compromise, chemo- and radiotherapy, immunosuppression, Crohn's disease, and alcohol abuse. High mortality results from the rapid progress of the disease, leading to quick development of septic shock and multi-organ failure. Most important in the treatment of Fournier's gangrene are surgical debridement of the wound, fascia incision and drainage of necrotic lesion, and intravenous antibiotic therapy. The typical picture of the disease might be hidden by concomitant disease.
Material and Method
A case of Fournier's gangrene in an 81-year-old woman with concomitant neurologic complications, hypertension, cardiomyopathy, and chronic obstructed pulmonary disease is described. Three days after the suspected diagnosis, the decision was made to fully remove the necrotic tissue surgically. Despite all the efforts of the medical team, the patient died 14 days after being diagnosed with Fournier gangrene. The immediate cause of death was septic shock.
Results

Conclusions
In the early stages of the disease, before necrotic lesions occur, a final diagnosis might be difficult. In the present case, death was caused by the patient's advanced age, simultaneously appearing symptoms, and late surgical intervention, but mostly by lung failure.

Keywords: Necrosis - pathology, Tomography, X-Ray Computed, History, 21st Century, History, 20th Century, History, 19th Century, Fournier Gangrene - radiography, Aged, 80 and over

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