Fournier’s Gangrene in the Setting of Underlying Carcinoma: A Case Report and Review of the Literature

Abstract

Most case series of Fournier's gangrene (FG) do not list malignancy as a cause; however, isolated cases with underlying malignancy of the soft tissue, genitourinary, and gastrointestinal systems have been described. After a review of recently published literature, 20 case reports and 15 case series or review articles included relevant information and were included in this literature review. Malignancy is overlooked in 10% (2/20) of patients, resulting in a delayed diagnosis and initiation of cancer treatment. All patients with FG should have a thorough cancer history, digital rectal examination, appropriate local and systemic imaging, as well as tissue biopsies, to reduce the likelihood of a missed cancer diagnosis. Delay in management of the local malignancy may lead to persistence or recurrence of the infection and significantly worsens overall outcome and survival.

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

“…Some examples are penetrating trauma, urological/gynecological/analogical procedures, insect bites, skin tears, and hemorrhoids. Infections are often polymicrobial with anaerobic and aerobic bacteria infecting the fascial planes [8]. Common organisms grown in wound cultures are Group A Streptococci, S. aureus, and gramnegative such as E. coli and Pseudomonas [7][8].…”

“…Infections are often polymicrobial with anaerobic and aerobic bacteria infecting the fascial planes [8]. Common organisms grown in wound cultures are Group A Streptococci, S. aureus, and gramnegative such as E. coli and Pseudomonas [7][8].…”

“…Most cases of FG are polymicrobial; therefore, the broad-spectrum antibiotics should be started immediately after obtaining blood cultures and, if possible, tissue cultures. The antibiotic regimen should cover Staphylococcus, Enterococcus, E. coli, and other gram-negative pathogens and anaerobes (including Bacteroides and Clostridium species) [8]. The current Infectious Diseases Society of America (IDSA) guidelines recommend vancomycin or linezolid plus one of the following agents: piperacillin-tazobactam, a carbapenem, or ceftriaxone-metronidazole.…”

An unusual case of malignant mesothelioma mimicking as Fournier’s gangrene

“…15 Differential diagnosis of Fournier's gangrene in the setting of an underlying malignancy on histopathological examination includes rectal adenocarcinoma, colonic adenocarcinoma, prostatic adenocarcinoma, scrotal pleomorphic sarcoma, urethral squamous cell carcinoma and scrotal squamous cell carcinoma. 16 Most patients are initially treated conservatively for a suspected benign entity and the diagnosis of malignancy is often made postoperatively. On subjecting the specimen to immunohistochemical assay, calretinin staining is positive in malignant mesothelioma.…”