Fournier gangrene is the name given to necrotizing fasciitis involving the genital, perianal, or perineal regions.
Gangrene results when the infection leads to thrombosis of the regional subcutaneous blood vessels. It is usually polymicrobial. Escherichia coli is the most commonly isolated organism. Fournier gangrene results from anorectal abscesses, pressure ulcers, trauma to the anogenital region (eg, surgical procedures, episiotomies, chronic urethral catheterization, pubic hair shaving), or spread of infection from nearby perineal structures (eg, perianal glands, Bartholin ducts, urinary tract infection). Individuals with diabetes mellitus, spinal cord injuries, or chronic alcohol use disorder or who are otherwise immunosuppressed are at increased risk for Fournier gangrene. Men are affected much more frequently than women.
Patients with Fournier gangrene are acutely ill. They are often thought to have cellulitis that is not responding to standard antibiotic therapy. There is commonly a paucity of cutaneous findings in the early course of the disease. Pain is out of proportion to physical findings. Patients present with pain, swelling, and erythema in the genital region that rapidly evolves to bullae formation and skin necrosis. Signs of systemic illness such as fever, lethargy, hypotension, and tachycardia are present; these may progress to multiorgan failure.
The mortality of Fournier gangrene is high. Treatment includes broad-spectrum intravenous (IV) antibiotics and immediate surgical debridement of infected and devitalized tissue. If you are considering this diagnosis, contact a surgeon now.
Potentially life-threatening emergency
Fournier gangrene
See also in: Cellulitis DDx,AnogenitalAlerts and Notices
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Synopsis
Codes
ICD10CM:
N49.3 – Fournier gangrene
SNOMEDCT:
398318005 – Fournier gangrene
N49.3 – Fournier gangrene
SNOMEDCT:
398318005 – Fournier gangrene
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Cellulitis or erysipelas
- Angioedema
- Abscess / pilonidal abscess
- Vulvar edema
- Calciphylaxis
- Disseminated intravascular coagulation / purpura fulminans
- Ecthyma gangrenosum
- Gas gangrene
- Group A streptococcal necrotizing fasciitis
- Balanitis
- Granuloma inguinale
- Lymphogranuloma venereum
- Epididymitis
- Orchitis
- Vasculitis
- Testicular torsion
- Red scrotum syndrome
- Granulomatosis with polyangiitis
- Strangulated hernia
- Pyoderma gangrenosum
- Juvenile gangrenous vasculitis of the scrotum
- Lipschutz ulcer
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:05/01/2019
Last Updated:04/26/2020
Last Updated:04/26/2020
Potentially life-threatening emergency
Fournier gangrene
See also in: Cellulitis DDx,Anogenital