Coexistence of human immuno deficiency virus, diabetes mellitus, epididymal cysts, and Fournier's gangrene: A case report

Fournier's gangrene (FG) is a form of necrotizing fasciitis that is localized in the external genital organs and perianal region and causes skin and subcutaneous tissue gangrene. The clinical picture may vary depending on the patient's comorbidities and the extent of infection; Many predisposing conditions such as immunodeficiency, diabetes, alcoholism encourage the spread of the infection. In this case report, we highlighted the importance of emergency debridement in patients with multiple comorbidities by presenting the Fournier's Gangrene case in a 57-year-old immunosuppressive male patient with cystic lesions in the epididymis, with a history of hypertension, coronary artery disease, diabetes, HIV (human immunodeficiency virus) and a history of bipolar disorder. The patient, who was operated on for debridement by the urology, was given 1x500mg daptomycin, 3x1g meropenem, 3x450mg clindamycin IV treatment. The patient was discharged with full recovery after 17 days of hospitalization. Clinical suspicion in Fournier's gangrene cases, early surgical debridement, and extended-spectrum anti biotherapy are important. with rapid diagnosis and treatment in patients with improvement can also be seen in patients with comorbidities.

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Fulminant Fournier’s gangrene in a patient with gastric cancer treated with ramucirumab and paclitaxel

Therapeutic Advances in Drug Safety ◽

10.1177/2042098620946556 ◽

2020 ◽

Vol 11 ◽

pp. 204209862094655

Author(s):

Zoran Rakusic ◽

Ana Misir Krpan ◽

Ivica Sjekavica

Keyword(s):

Gastric Cancer ◽

Subcutaneous Tissue ◽

Growth Factor Receptor ◽

Multiple Organ ◽

Fournier’S Gangrene ◽

Vascular Endothelial ◽

Clinical Progression ◽

Perianal Region ◽

Fournier's Gangrene ◽

Endothelial Growth Factor

Fournier’s gangrene (FG) is an uncommon form of necrotizing fasciitis, localized on the external genital organs, perianal region, and abdominal wall, accompanied by thrombosis of the feeding arteries, leading to gangrene of the skin and subcutaneous tissue, with manifestations of rapid clinical progression and multiple organ failure. Ramucirumab is a recombinant human immunoglobulin G1 monoclonal antibody that binds to the extracellular binding domain of vascular endothelial growth factor receptor-2 (VEGFR-2) and prevents the binding of all VEGFR ligands. The literature describes bevacizumab, aflibercept, and regorafenib associated with FG in patients with colorectal cancer. According to our knowledge this is the first report of FG possibly related to ramucirumab in a patient with gastric cancer. If not recognized in time, it can lead to fatal complications.

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Fournier’s gangrene and intravenous drug abuse: an unusual case report and review of the literature

Open Medicine ◽

10.1515/med-2019-0114 ◽

2019 ◽

Vol 14 (1) ◽

pp. 694-710

Author(s):

Michele Del Zingaro ◽

Andrea Boni ◽

Jacopo Adolfo Rossi De Vermandois ◽

Alessio Paladini ◽

Emanuele Lepri ◽

...

Keyword(s):

Case Report ◽

Methadone Maintenance ◽

Subcutaneous Fat ◽

External Genitalia ◽

Fournier’S Gangrene ◽

Review Of The Literature ◽

Fournier's Gangrene ◽

History Of ◽

Subcutaneous Fat Tissue ◽

Unusual Case Report

AbstractFournier’s gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes.In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia.Fournier’s gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature.

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Fournier's gangrene as Amyand's hernia complication

Perspectives in Surgery ◽

10.33699/pis.2019.98.7.291-296 ◽

2019 ◽

Vol 98 (7) ◽

pp. 291-296

Keyword(s):

Case Report ◽

Case Reports ◽

Rare Condition ◽

Sporadic Case ◽

Fournier’S Gangrene ◽

Amyand’S Hernia ◽

Fournier's Gangrene ◽

Randomized Controlled Studies ◽

Based Medicine ◽

Hernia Complication

Introduction: Fournier’s gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyand’s hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyand’s hernia is verified. Fournier’s gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports. Case report: The case report of a 70-year-old patient with Fournier’s gangrene resulting from gangrenous appendicitis of Amyand’s hernia. Conclusion: Fournier’s gangrene as a complication of Amyand’s hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyand’s therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fournier’s gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.

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MICROBIOLOGICAL PROFILE, ANTIBIOTIC SENSITIVITY AND PROGNOSIS OF PATIENTS WITH FOURNIER’S GANGRENE: A PROSPECTIVE, HOSPITAL BASED STUDY FROM NORTH INDIA

10.36106/ijar/4102890 ◽

2021 ◽

pp. 78-80

Author(s):

Sanjay Gupta ◽

Ajay Kumar ◽

Adiveeth Deb

Keyword(s):

Mortality Rate ◽

Acinetobacter Baumannii ◽

Ventilatory Support ◽

Antibiotic Sensitivity ◽

Fournier’S Gangrene ◽

North India ◽

Klebsiella Pneumonia ◽

Bacterial Strains ◽

Perianal Region ◽

Fournier's Gangrene

Background: Fournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotic therapy for FG. Materials and Methods: Data from patients who underwent surgery for FG was retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated. Outcome was also assessed in terms of mortality. Results: Fifty patients with a median age of 58.5 (40-83) years were included. The perianal region and scrotum (88%) were the most commonly affected. Diabetes mellitus (DM) was the most common comorbidity (92%). The median time to onset of symptoms was 7 (2-15) days, and the median duration of hospital stay was 22 (4-65) days. Ventilator requirement was required in 15 (30%) patients. The median UFGSI score was 9.5 (3-15). The overall mortality rate was 26%. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0-10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (68%). Acinetobacter baumannii and Klebsiella pneumonia were signicantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of > 9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate. Conclusion: Causative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modied. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.

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Subcutaneous Emphysema Secondary to Tonsillectomy

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1194 ◽

2015 ◽

Vol 7 (2) ◽

pp. 78-80

Author(s):

Vivek Sasindran ◽

Vijay Stephen ◽

Lakshana Deve

Keyword(s):

Case Report ◽

Surgical Procedures ◽

Subcutaneous Emphysema ◽

Subcutaneous Tissue ◽

Rare Complication ◽

Tension Pneumothorax ◽

Tonsillar Fossa ◽

Superior Constrictor ◽

History Of ◽

Fatal Complications

ABSTRACT Background Tonsillectomy is one of the most common surgical procedures performed worldwide. However, it can potentially be associated with several complications. One of the very rare complications post-tonsillectomy in adults is subcutaneous emphysema, as in our case here. Although, most reported cases are resolved spontaneously, it may lead to fatal complications, like tension pneumothorax. Case report Tonsillectomy was performed on an adult patient with history of frequent tonsillitis. The patient developed facial subcutaneous emphysema 48 hours after the surgery (evident by clinical and radiological examination) that resolved within 2 days without further complications. Conclusion Tonsil should be removed along with tonsilar capsule. If tonsillectomy causes deeper than usual mucosal tear up to the level of the muscles, then air might pass into the subcutaneous tissue through the tonsillar fossa and superior constrictor muscle into fascial layers of neck. Emphysema can then spread to parapharyngeal, retropharyngeal spaces and mediastinum with its related morbidity. Though a rare complication, all otorhinolaryngologists must be aware of this complication and its management. How to cite this article Abraham SS, Stephen V, Deve L, Kurien M. Subcutaneous Emphysema Secondary to Tonsillectomy. Int J Otorhinolaryngol Clin 2015;7(2):78-80.

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945. Prevalence of HIV Associated Non-AIDS Conditions and Associated Risk Factors among Hospitalized HIV-infected Patients in India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1131 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S504-S505

Author(s):

Amyeo A Jereen ◽

Celia Kucera ◽

Saniya Pervin ◽

Muralidhar Varma ◽

Radhakrishnan Rajesh ◽

...

Keyword(s):

Risk Factors ◽

Transmitted Disease ◽

Multivariate Logistic Regression Analysis ◽

Patient Risk ◽

Sexually Transmitted ◽

Factors Associated ◽

Immunodeficiency Virus ◽

History Of ◽

Artery Disease ◽

Associated Risk Factors

Abstract Background HIV-associated non-AIDS (HANA) conditions are becoming common as People Living with Human Immunodeficiency Virus (PLWHIV) age. However, data estimating the prevalence of HANA conditions and associated risk factors is lacking in developing countries. This study evaluates reasons for hospitalizations among PLWHIV in Udupi, India in the antiretroviral era, and describes associated risk factors. Methods Demographic and clinical data were extracted from medical charts of 1280 HIV-infected patients 18 years and older who were admitted to Kasturba Hospital, Manipal, India between January 1, 2013 and December 31, 2017, for a total of 2157 hospitalizations. Primary reasons for hospitalization were categorized into AIDS-defining vs Non-AIDS-defining and HANA vs Non-HANA conditions (Fig 1). Multivariate logistic regression analysis was performed to estimate demographic and clinical factors associated with hospitalizations due to AIDS-defining illness and HANA conditions. Categorization of Reasons for Hospitalization Results Patients’ median age was 45 (18-80) years; 70% male. Median age of patients with AIDS-defining illness (45% of hospitalizations) was lower at 44 (18-75) years compared with HANA (15% of hospitalizations) at 48 (21-80) years. Age (OR, 95% CI) (0.985, 0.974-0.995), admission CD4 (0.998, 0.997 - 0.998), history of hypertension (HTN) (0.59, 0.42-0.82), stroke (0.49, 0.24 - 0.93), diabetes (1.56, 1.10 - 2.19), and AIDS-defining cancers (1.74, 1.05 - 2.89) were associated with AIDS-defining hospitalizations (Fig 2). Additionally, age (1.016, 1.001 - 1.031), history of HTN (1.70, 1.16 - 2.46), coronary artery disease (CAD) (4.02, 1.87- 9.02), chronic kidney disease (CKD) (2.30, 1.15 - 4.61), stroke (2.93, 1.46 - 5.96), Hepatitis B (3.32, 1.66- 6.72), Hepatitis C (16.1, 2.84 - 314), sexually transmitted disease (STD) (3.76, 1.38- 10.8), and HANA-associated cancer (2.44, 1.28- 6.42) were associated with HANA hospitalizations (Fig 3). Patient Risk Factors for AIDS-related Hospitalization Patient Risk Factors for HANA-related Hospitalization Conclusion Prevalence of HANA conditions was lower than AIDS-defining illnesses possibly because of a younger population. Patients with AIDS-defining illnesses were also likely to have HANA conditions. Early detection and effective treatment of both HIV and HANA conditions is essential to decrease hospitalizations in low-resource settings. Disclosures All Authors: No reported disclosures

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Fournier’s gangrene secondary to male’s circumcision – a case report and review of the literature

Acta Chirurgiae Plasticae ◽

10.48095/ccachp202196 ◽

2021 ◽

Vol 63 (3) ◽

Author(s):

Massimiliano Tripoli ◽

Emanuele Cammarata ◽

Adriana Cordova

Keyword(s):

Case Report ◽

Fournier’S Gangrene ◽

Review Of The Literature ◽

Fournier's Gangrene

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Fournier's Gangrene of Genitalia: Case Report

Urologia Journal ◽

10.1177/039156030307001-408 ◽

2003 ◽

Vol 70 (1-4) ◽

pp. 38-40

Author(s):

P. Salciccia ◽

G. Poveromo ◽

S. Salciccia

Keyword(s):

Septic Shock ◽

Case Report ◽

Early Diagnosis ◽

Rare Disease ◽

Abdominal Wall ◽

Sudden Onset ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Prodromal Symptoms

Fournier's gsngrene is a rare disease involving the scrotum and the penis with occasional extension up to the abdominal wall. The etiology of the disease, commonly without prodromal symptoms and with sudden onset, is still not fully understood. The organisms are usually streptococcus haemoliticus and/or anerobic bacteria. We report a case of Fournier's gangrene, presenting septic shock. The patient was treated with reanimatory care, antibiotics, local excision and debridment. Speaking about anatomical and etiopathogenetic hypotheses, we discuss the diagnostic problems and the treatment of the disease. We emphasize the role of the early diagnosis.

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