[A female case of Fournier's gangrene in a patient with lupus nephritis].
Infection is one of the common causes of death in patients with systemic lupus erythematosus (SLE). It is associated with the use of immunosuppressive agents, renal failure, and increased disease activity. Fournier's gangrene is a necrotizing fasciitis occurring in the genital region. It is rare, but can be crucial if surgical drainage is delayed. We report a female case of Fournier's gangrene occurring in a patient with lupus nephritis and chronic renal failure. The patient was a 21-year-old female with chronic renal failure due to lupus nephritis. She had suffered from watery diarrhea one month before admission. It improved after increasing the dose of prednisolone, but, she was complicated with Bartholin abscess. The vaginal pain rapidly spread to the left lower quadrant abdomen despite treatment with oral cephalosporin. Focal incision was performed and black fluid emerged with a foul smell. Pelvic computed tomography (CT) revealed many bubbles in that region. She was found to have septic shock on transfer to our hospital. Thereafter, emergency debridement was performed, followed by antibiotic therapy and hyperbaric oxygen therapy. Organisms were found to be 5 anerobes, such as Bacteroides species, and 3 aerobics, such as Morganella morganii. Fournier's gangrene was improved via these treatments, but she needed maintenance hemodialysis. Fournier's gangrene complication should be considered in SLE with urogenital infection.
Kohagura
K
K
Third Department of Internal Medicine, School of Medicine, University of The Ryukyus, Okinawa, Japan.
Sesoko
S
S
Tozawa
M
M
Iseki
K
K
Tokuyama
K
K
Fukiyama
K
K
D000328:Adult; D019115:Fasciitis, Necrotizing / Q000209:etiology; D005260:Female; D018934:Fournier Gangrene / Q000209:etiology*; D005831:Genital Diseases, Female / Q000209:etiology*; D006801:Humans; D008181:Lupus Nephritis / Q000150:complications*