An Unusual Bacterial Etiology of Fournier’s Gangrene in an Immunocompetent Patient

Abstract

Fournier's gangrene (FG) is necrotizing fasciitis that affects the penis, scrotum, or perineum. Males are more likely to get affected by this disease. The most common predisposing risk factors are diabetes, alcoholism, hypertension, smoking, and immunosuppressive disorders. FG is a polymicrobial infection caused by both aerobic and anaerobic bacteria. The most common aerobic organisms are Escherichia coli, Klebsiella, Proteus, Staphylococcus, and Streptococcus. The most common anaerobic organisms are Bacteroides, Clostridium, and Peptostreptococcus. The disease carries high mortality and morbidity, so timely diagnosis and treatment are of utmost importance.Here, we report a case of a 61-year-old male with a medical history significant for benign prostatic hyperplasia (BPH), who presented to our hospital with fever, watery diarrhea, and painful swelling of the scrotum and penis. The patient was started on piperacillin-tazobactam, vancomycin, and clindamycin. A computed tomography scan of the pelvis showed prostatic enlargement, edema of the penis and scrotum, and air collection within the corpus cavernosum. The patient underwent multiple surgical debridements of the glans penis. Patient wound cultures were positive for Streptococcus anginosus, Actinomyces turicensis, and Peptoniphilus harei. As mentioned earlier, FG is common in diabetic and immunocompromised patients, and infection is usually polymicrobial. Our patient was immunocompetent and his cultures grew atypical organisms.

Case report: A rare case of skin abscess caused by coinfection of Actinobaculum schaalii and Actinomyces turicensis

“…One limitation in our case report is the presence of a microbial infection that lacks a discernible etiology. The most prevalent risk factors for these infections include advanced age, urologic-related predisposing diseases, and immunosuppressive illnesses ( Lotte et al., 2016 ; Khan et al., 2022 ). However, none of these identified risk factors align with the characteristics exhibited by our patient.…”

A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-Conserving Surgery for Breast Cancer and Literature Review

“…It is not a common single-pathogen, often co-infecting with other microorganisms, and is considered an anaerobe coexisting in chronic wounds or diabetic ulcers [5]. Our literature review of reported cases infected by P. harei (Table 3) found instances involving implants, brain, abdomen, vessels, etc [4][5][6][7][8][15][16][17][18]. Only three cases of breast abscess caused by P. harei have been reported, all with concurrent actinomycosis infection[6-8] In contrast, our reported case of breast abscess caused by P. harei is unique, as it was a single infection without other identi ed pathogens.…”

The Value of Fournier’s Gangrene Scoring Systems on Admission to Predict Mortality: A Systematic Review and Meta-Analysis

“…FG is usually a polymicrobial infection caused by aerobic Gram-negative bacilli or Gram-positive cocci. The most frequently identified bacterial species, upon culture, are Enterobacteriaceae, such as E. Coli , followed by streptococcal species [ 49 ]. Other organisms that are frequently isolated include Staphylococci , P. aeruginosa , Peptostreptococci , Bacteroides spp., and Clostridia [ 49 ].…”