Extensive fournier gangrene with retroperitoneal involvement in a diabetic patient

Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions extending to the abdominal wall between the fascial planes. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. A 42 year old male who is an alcoholic and diabetic on irregular treatment presented with scrotal swelling and pain for 5 days following a trauma. On examination, patient was febrile, tachypneic and had tachycardia. His scrotum was edematous and erythematous on right side with crepitus. Abdomen was warm on right side till umbilicus and had crepitus. He was in sepsis and had diabetic ketoacidosis, prerenal azotemia and mild impairment of liver function. A diagnosis of extensive Fournier gangrene with retroperitoneal involvement was made. Patient underwent scrotal exploration and aggressive debridement serially. Testis was spared. As patient improved with good wound care and glycemic control, wound was closed. Though our patient had retroperitoneal involvement without peritonitis, he was deferred laparotomy which significantly reduced the morbidity and mortality. It is one of the few reported case in the literature with retroperitoneal involvement.

A rare case of varicella gangrenosum in adult

Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. It most commonly occurs in children less than 5 years of age and life threatening. This is a very rare complication of chicken pox in adults which deserves early diagnosis and management. 21-year-old male presented with blackish discoloration in the lateral aspect of right thigh for 5 days. He has positive history of chicken pox for his brother and sister following which he acquired it 15 days back. During that episode he had fever, headache and blisters which ruptured to heal by scab. But scab in right thigh coalesced to form the gangrenous area with serous discharge. On presentation he had no fever with local lesion and surrounding erythema. Patient underwent radical surgical debridement and regular dressing. Pus culture was sent which showed no growth. He gradually improved and the ulcer granulated well and split skin graft is done. Varicella gangrenosum is a life-threatening condition which can be either wet, moist or purpura fulminans. Patients who develop disseminated intravascular coagulation and have a grave prognosis. Surgical debridement is the only proven treatment which has led to better outcome. Only about 10 cases reported in literature so far regarding this condition.