Fournier gangrene associated with Crohn disease.

A 17-year-old boy presented with Fournier gangrene associated with previously undiagnosed Crohn ileocolitis. Fournier gangrene was managed by débridement, broad-spectrum antibiotics, and hyperbaric oxygen. A diverting ileostomy was performed before skin grafting and scrotal reconstruction. Microscopy of a full-layer surgical sample from the terminal ileum revealed granulomas with multinucleated histiocytes, consistent with Crohn disease. Crohn disease was treated with mesalamine, metronidazole, 6-mercaptopurine, and infliximab. The patient was discharged on hospital day 32. At 6-month follow-up, reconstruction of his scrotum had completely healed. Ostomy output was normal.

Parvovirus and epidemic arthritis.

Five cases of acute polyarthritis in individuals with serologic evidence of recent human parvovirus B19 infection were seen in one medical practice. Several individuals had had direct exposure to children with rash, and fifth disease was endemic in the community. All cases were associated with the presence of both IgG and IgM antibody to human parvovirus.

Candidal costochondritis responsive to ketoconazole in an iv drug abuser.

Infections caused by Candida albicans have been reported in many organ systems in intravenous drug users. Amphotericin B (Fungizone) has been shown to be effective in treatment. However, because of its numerous side effects and difficulty in maintaining intravenous access in this population, the agent is difficult to use. Ketoconazole (Nizoral), administered orally, is a more convenient and better tolerated agent and was efficacious in the case of candidal costochondritis described here. Further evaluation of ketoconazole is needed to better define its role in the treatment of disseminated candidiasis, particularly in cases associated with intravenous drug abuse.