Student Presenter(s): Madiha Khan
Faculty Mentor: Martine Louis
Department: Clinical Sciences
School/College: College of Osteopathic Medicine, Long Island

Introduction:

Fournier’s gangrene is a rapidly progressive necrotizing fasciitis invading the planes of the perineal region. It can be mistaken for other pathologies like hematoma, phlebitis, cellulitis, or septic arthritis. Herein we describe the case of a patient in whom Fournier’s gangrene was mistaken for a burn.

Case:

A 77-year-old male with a history of coronary artery disease presented with a right gluteal fold wound with extension to the perineal region for one day. Vital signs were unremarkable. On physical examination, bilateral perineum and gluteal folds appeared erythematous with desquamation and one fluid-filled blister as well as one ruptured blister, consistent with a second degree-burn. Labs were significant for a white blood cell count of 29.1 K/uL. A transfer to a burn facility was implemented and a CT scan of the abdomen/pelvis revealed the presence of numerous abnormal foci of air involving the tissues of the perineum extending into the proximal right thigh consistent with Fournier’s gas gangrene. The patient was urgently taken to the operating room for surgical debridement and placed on broad-spectrum antibiotics (Vancomycin, Zosyn, and Clindamycin). Wound cultures revealed the presence of Escherichia coli and Enterococcus avium. He was discharged home on postoperative day 12 and seen in the clinic with an almost healed wound (5mm) at 5 weeks post-discharge.

Conclusion:

It's vital to recognize the innocuous presentation of necrotizing fasciitis and treat it promptly.