Fournier gangrene is a necrotizing soft tissue infection of the perineum, genitals and perianal area caused by a mix of bacteria. It spreads quickly along fascial planes, is most common in men with diabetes, and needs urgent surgery for survival.
Key symptoms
- Severe genital or perineal pain out of proportion to the skin findings
- Swelling and redness of the scrotum or perineum
- Fever, chills and feeling very unwell
- Foul-smelling drainage
What you find on exam
- Tense swelling, dusky or black skin
- Crepitus from gas in the tissues
- Fast heart rate, low blood pressure or confusion
- Check the anus and urethra for a source
Tests
- Blood count, electrolytes, glucose, creatinine and lactate
- Blood cultures and wound cultures
- CT pelvis to show gas and extent, without delaying surgery
- Clinical diagnosis confirmed by surgical exploration
Treatment basics
- Emergency surgical debridement, often repeated
- Broad-spectrum IV antibiotics such as vancomycin plus piperacillin-tazobactam and clindamycin
- Sepsis care: fluids and vasopressors as needed
- Blood sugar control, wound care and later reconstruction
Red flags
- Crepitus or rapidly spreading skin changes
- Septic shock
- Pain far worse than the skin shows
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.