Abstract
A 69-year-old man with Fournier gangrene was transferred to our emergency department. He had experienced dysuria and had self-inserted a straw into his external urethral orifice. His pubic region became remarkably enlarged 2 days later, and a diagnosis of Fournier gangrene was made at another hospital. His consciousness was clear, respirations were 31/minute, pulse was 122/minute, and his blood pressure was 150/85 mmHg on arrival. Redness, swelling, and subcutaneous emphysema were present from the trunk to the bilateral upper thighs around the perineum, and a foul odor of sake lees was noticed from the incised area of the perineum. Retrograde urography revealed injury to the urethra. The Fournier gangrene had improved almost completely by disease day 46 after antimicrobial agent administration, incision and drainage, debridement, and daily irrigation had been performed. The patient had a history of untreated diabetes, and drainage from the wound area on the first day revealed Candida glabrata, suggesting that the causative pathogen was Candida. Fournier gangrene is a comparatively rare disease, and reports assuming the causative pathogen to be a fungus are extremely rare. In patients compromised by a disease such as diabetes, fungus may also be considered as a causative pathogen of Fournier gangrene.
