Pediatric Fournier’s Gangrene During Reinduction Therapy for Acute Lymphoblastic Leukemia: A Case Report

Abstract

Fournier’s gangrene is extremely rare in children and can be fatal because of sepsis or multiple organ failure. We report a case of the successful management of Fournier’s gangrene occurring during chemotherapy for acute lymphoblastic leukemia (ALL). A 3-year-old girl developed septic shock caused by Pseudomonas aeruginosa during reinduction therapy for relapsed ALL. Although the shock improved, erosions appeared on the left buttock, and she was referred to our department on hospital day 4. Abdominal contrast CT showed no abscess formation or gas, but the following day, the lesion expanded with elevated CK, AST, ALT, and LDH levels. Fournier’s gangrene was diagnosed, and debridement of necrotic gluteal tissue and diversion with sigmoid colostomy were performed. Subsequent progression of fasciitis to the lower abdomen required additional incision, and laparoscopic-assisted abdominoperineal resection was performed for rectal necrosis. After skin grafting, wound healing was achieved, and chemotherapy was resumed. Fournier’s gangrene can progress rapidly if its diagnosis is delayed. In immunocompromised patients, typical imaging findings such as abscess or gas formation may be absent; therefore, careful and serial physical examinations are crucial for early detection and treatment.