Fournier gangrene as a polymicrobial infection complication in a diabetic patient: a case report

Gangrena de Fournier como complicación de una infección polimicrobiana en un paciente diabético: informe de un caso

Resumen

Introduction: Fournier gangrene (FG) is a rare but life-threatening necrotizing fasciitis involving the genital and perineal regions, with mortality rates reaching up to 88%. The disease is typically caused by a polymicrobial infection involving both aerobic and anaerobic bacteria. Diabetes mellitus is the most common predisposing factor and is present in more than half of FG cases. Case overview: We report the case of a 58-year-old man with progressive painful scrotal swelling that initially appeared as a small lesion but gradually enlarged with discharged pus. The patient had a history of uncontrolled diabetes mellitus. Laboratory investigations showed hemoglobin 10.5 g/dL, leukocytosis (22.03×103/μL), thrombocytosis (583×103/μL), hyperglycemia (334 mg/dL), hypoalbuminemia (2.2 g/dL), elevated HbA1c (10.3%), and increased procalcitonin (3.36 ng/mL). Urinalysis demonstrated hematuria, leukocyturia, proteinuria, and significant bacteriuria. Urine culture grew Pseudomonas aeruginosa, while pus cultures yielded Escherichia coli and Proteus mirabilis. The patient received empirical cefotaxime and metronidazole therapy followed by surgical debridement. Antibiotic treatment was subsequently adjusted to ceftazidime according to culture and susceptibility results. Following six days of treatment, including adequate glycemic control, marked clinical improvement was observed, and the patient was discharged on oral ciprofloxacin. Conclusion: FG requires prompt management to achieve favorable outcomes and prevent severe complications.