title: Fournier's gangrene after adult male circumcision.
abstract: BACKGROUND
  In the advent of mass voluntary medical male circumcision (VMMC) for the partial prevention of HIV, previously rare adverse events associated with adult male circumcision are likely to be encountered with higher frequency. Fournier's gangrene, defined as a polymicrobial necrotizing fasciitis of the perineal, perianal or genital areas, is one such rare and life-threatening adverse event. In this report, we present two cases that were identified in the context of a VMMC programme over a 3-year period during which approximately 100,000 adult circumcisions were performed.
  
  
  METHODS
  Case 1: A 19-year-old male who had VMMC performed using the dorsal slit technique developed pain and blisters on the scrotal skin on the sixth postoperative day. He had no co-morbidities, and serology for HIV was negative. On examination, locally he had scrotal skin necrosis with an offensive odour and was dehydrated but afebrile. Repeated aggressive debridement was done while he stayed in a hospital for 3 weeks; at which point, he had healthy granulation tissue and was free of infection. The wound had closed spontaneously and completely by the fifth month. Case 2: A 52-year-old male who had VMMC performed with the sleeve resection method developed pain and swelling of the penis and scrotum on the fourth postoperative day. He had a low-grade fever of 37.6°C. He was not diabetic or immunosuppressed and had a negative HIV serology. He was admitted and was given IV antibiotics, and repeated aggressive debridement was performed. On the third week of hospitalization, he had healthy granulation tissue and received a split skin graft on the penile shaft. At 4 months, the scrotal defect had completely closed.
  
  
  CONCLUSIONS
  Fournier's gangrene is a rare occurrence after adult male circumcision with associated high morbidity. These are the first descriptions in the VMMC era.
authors: International Hospital Kampala, Namuwongo P.O. Box 8177, Kampala, Uganda.
authors: Moses
authors: M
authors: Galukande
authors: Infectious Diseases Institute, Makerere University, Kampala, Uganda.
authors: Dennis Bbaale
authors: DB
authors: Sekavuga
authors: Infectious Diseases Institute, Makerere University, Kampala, Uganda.
authors: Alex
authors: A
authors: Muganzi
authors: Infectious Diseases Institute, Makerere University, Kampala, Uganda.
authors: Alex
authors: A
authors: Coutinho
keywords: Adult; Circumcision; Gangrene; Male
references: East Afr Med J. 1998 Jun;75(6):370-3
references: 9803623
references: Lancet. 2007 Feb 24;369(9562):643-56
references: 17321310
references: BJU Int. 2012 Dec;110(11 Pt C):E1096-100
references: 22726768
references: Infection. 2009 Aug;37(4):306-12
references: 19629386
references: Scand J Infect Dis. 2004;36(8):610-2
references: 15370675