[Fournier gangrene (necrotizing fasciitis) in a woman with diabetes mellitus].
METHODS
A 67-year-old woman with insuline-dependent diabetes mellitus and chronic alcohol abuse was admitted with impaired consciousness and fever. Physical examination showed a livid induration of the perineal and vaginal soft tissues with crepitations.


METHODS
Laboratory tests showed greatly elevated infection parameters. Abdominal computed tomography revealed perineal and vaginal subcutaneous gas accumulation extending into the ventral abdominal wall.


METHODS
The combination of an obscure infection and subcutaneous genital gas accumulation suggested the diagnosis of Fournier gangrene, a necrotizing fasciitis. In spite of administration of broad-spectrum antibiotics and repeated surgical removal of necrotic tissue the patient died of multiple organ failure.


CONCLUSIONS
Successful treatment of Fournier gangrene critically depends on immediate treatment. Administration of broad-spectrum antibiotics and aggressive surgical resection of the necrotic tissue may prevent continuing spreading of the infection. Computed tomography provides an early diagnosis and guides the presurgical evaluation of the subcutaneous spread.
Kamper
Lars
L
Klinik für diagnostische und interventionelle Radiologie, HELIOS Klinikum Wuppertal, Universitätsklinikum Witten/Herdecke, Wuppertal. lars.kamper@helios-kliniken.de
Piroth
W
W
Haage
P
P
D000368:Aged; D000437:Alcoholism / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003244:Consciousness Disorders; D003646:Debridement; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D005334:Fever; D018934:Fournier Gangrene / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D007004:Hypoglycemic Agents; D007328:Insulin