This 29-year-old obese diabetic man presented in a state of septic shock, requiring resuscitation in the Intensive Care Unit.
On examination,following picture was seen.What can be the most possible diagnosis?
A. Scrotal abscess
B. Testicular torsion
C. Acute epididymo-orchitis
D. Fournier gangrene
Ans:D. Fournier gangrene.
- It is defined as a polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas.
- It is usually caused by a mixed infection of both aerobic and anaerobic bacteria.
- They present with systemic toxicity and pain over the perineum. Cellulits is seen in the patient but they may present with crepitance and extensive necrosis under relative normal skin.
- Synergistic flora of the anorectal and urogenital area (streptococcus, clostridia, and non-hemolytic streptococcus).
- Immuno-compromised patients (e.g. diabetics, alcoholics and malnourished patients).
- They are associated with high morbidity and mortality. Aggressive surgical debridement and broad spectrum antibiotics is necessary.