title: Perineal-onset Fournier's gangrene in a patient undergoing hemodialysis--importance of perineal-onset manifestation.
abstract: We present a rare case of perineal-onset Fournier's gangrene in a patient undergoing hemodialysis. A 51-year-old Japanese man manifested an acute-onset perineal pain with perirectal abscess; subsequently, the pain extended to the abdomen, chest, and loin despite quick treatment. His consciousness deteriorated to delirium and he died of septic shock on the third day of admission. Computed tomography (CT) revealed soft-tissue air along the right rectal wall, moreover, the infection extended to the anterior wall of the bladder and the right peripsoas muscle. On the basis of the clinical course and CT findings, the patient was diagnosed as having the complications of Fournier's gangrene, however, no scrotal lesions were detected. Fournier's gangrene is considered to be easily diagnosed on the basis of skin lesions, such as scrotal erythema and swelling. However, in the early stage, the diagnosis of Fournier's gangrene is difficult in a patient with perineal pain before the detection of skin lesions. In conclusion, definitely the key to improving the prognosis of this fulminant infection is the prompt recognition of the pathological process. Therefore, Fournier's gangrene should always be considered when patients undergoing hemodialysis manifest perirectal disorders, even when no scrotal lesions are detected, because there is the possibility of intra-abdominal and intra-retroperitoneal infections resulting in septic shock.
authors.affiliation: Department of Internal Medicine, Kanto Rosai Hospital, Kanagawa, Japan. h-mon@east.dts.ne.jp
authors.forename: H
authors.initials: H
authors.lastname: Nakamura
authors.forename: K
authors.initials: K
authors.lastname: Katizawa
authors.forename: Y
authors.initials: Y
authors.lastname: Inada
authors.forename: N
authors.initials: N
authors.lastname: Kato
authors.forename: M
authors.initials: M
authors.lastname: Mukai
authors.forename: M
authors.initials: M
authors.lastname: Akashi
authors.forename: T
authors.initials: T
authors.lastname: Sugisaki
mesh_terms: D000038:Abscess / Q000150:complications / Q000000981:diagnostic imaging; D017809:Fatal Outcome; D018934:Fournier Gangrene / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging / Q000209:etiology*; D010502:Perineum; D012002:Rectal Diseases / Q000150:complications / Q000000981:diagnostic imaging; D006435:Renal Dialysis; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed