ABSTRACT
Fournier's gangrene is a necrotizing fasciitis of the scrotal and inguinal region, associating high mortality and complication rates. It is extremely rare in the neonatal period and may be life threatening. We present an exceptional case of a 24-day-old boy who consulted to the emergency department for fever (39 °C) and an indurated, fluctuating and painful erythema in both groins, left hemiscrotum, left anterior femoral region and perineum for the last 6 hours. Blood analysis showed increased acute phase reactants without leukocytosis. Ultrasound revealed significant soft-tissue involvement. Due to high clinical suspicion and hemodynamic instability (tachycardia and prolonged capillary filling), urgent fasciotomy, placement of Penrose drains and intensive irrigation was performed. Wound care with irrigations was performed 3 times a day. During the 12 days neonatal intensive care unit admission, he required hemodynamic support and orotracheal intubation and sedation for pain control. Broad-spectrum antibiotic therapy (with cefotaxime, clindamycin and cloxacillin) was administered for 2 weeks. Ampicillin-sensitive Streptococcus pyogenes (Group A) was isolated in blood culture at 4th day of admission allowing antibiotic de-escalation. He was discharged on postoperative day 24. He has minimal, inconspicuous scars and no functional sequelae. Fever in neonates requires close observation considering the use of empirical broad-spectrum antibiotics and hospitalization. Early diagnosis, prompt surgical management and broad-spectrum antibiotic therapy are essential to prevent complication. Early fasciotomy with intensive irrigation and close survey may avoid extensive skin debridement.
Subject(s)
Debridement/methods , Fournier Gangrene/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Fasciitis, Necrotizing/diagnostic imaging , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Fournier Gangrene/drug therapy , Fournier Gangrene/surgery , Hospitalization , Humans , Infant, Newborn , Male , Scrotum/diagnostic imaging , Scrotum/pathology , Treatment Outcome , UltrasonographyABSTRACT
Introduction Urea cycle disorders (UCDs) form a group of metabolic pathological conditions that might develop serious neurological consequences. Early diagnosis, before irreversible damage is established, is the most important prognostic and morbidity factor. Case Report We present the case of a 5-day newborn with high blood pressure and respiratory distress. Diagnosis was type I citrullinemia. With appropriate citrullinemia guided-treatment blood pressure returned to normal. Conclusion High blood pressure has been rarely described as a lead symptom for the debut of a UCD. We must take this into consideration as an early recognition and treatment of these disorders are of the utmost importance.
