What's the Diagnosis? By Dr. Eric Chavis

72 yo M w/ PMHx of HTN, HLD, CKD (not on dialysis), DM and CAD presents to the ED with scrotal pain x 1 week. He is concerned that he has an "abcess" and wanted to be checked. A CT is done and shown below. What's the diagnosis? (scroll down for answer)







Answer: Fournier's Gangrene

  • Note CT scan above showing scrotal edema with subcutanteous air 
  • Fournier's Gangrene is a form of necrotizing fasciitis of the perineal, perianal and genital regions
  • Majority of cases affect males, but can occur in females
  • Most common comorbid conditions: DM and ETOH use
  • Exam may show cellulitis, crepitus, pain and skin necrosis
  • Typically polymicrobial infection
  • Early surgical debridement and antibiotics help limit mortality- but still as high as 20-30%
  • Once suspected--- call your surgeon!
    • Can get advanced imaging including CT scan if diagnosis not clear
  • Start broad spectrum antibiotics- vancomycin and carbapenem or piperacillin-tazobactam +/- clindamycin or metronidazole
    • Goal is to cover gram positive, gram negative, and anaerobes
  • Don't forget blood cultures and fluid resuscitation! 




Thwaini A, Khan A, Malik A, et al. Fournier's gangrene and its emergency management. Postgrad Med J. 2006;82(970):516-519