title: [Fournier's gangrene: Cervical and facial extension. A very rare case].
abstract: Fournier's gangrene is a fearsome disease with a bad prognosis and a mortality rate ranging between 10 and 80% according to the literature. It is extensive in 13 to 54% of cases. Up to date, cervico-facial extension has never been reported. We describe the case of a 51-year-old overweighed woman with a history of type 2 diabetes and a narrow lumbar canal who was referred to our institution for significant fatigue and increasingly painful legs. A diagnosis of Fournier's gangrene was made after correlating the physical findings with the results of a full body scan. Diffuse subcutaneous emphysema involving the face, neck, mediastinum, abdominal wall, right buttock, perineum and the right thigh was identified. Treatment included multiple surgical debridements, admission to intensive care unit, and an efficient antibiotic therapy that enabled preservation of the patient's life. To our knowledge, this is the first case of cervical and mediastinal extension of Fournier's gangrene to be reported. No clear guidelines exit on the management of this complication (cervico-facial and mediastinal drainage). We share our experience of this unusual case.
authors.affiliation: Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France. Electronic address: raphaelcarloni@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Carloni
authors.affiliation: Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Pechevy
authors.affiliation: Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France.
authors.forename: N
authors.initials: N
authors.lastname: Isola
authors.affiliation: Institut de recherches médicales A.-Lanari, université de Buenos-Aires, C1427ARO Buenos-Aires, Argentine.
authors.forename: L
authors.initials: L
authors.lastname: Vidal
authors.affiliation: Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France.
authors.forename: D
authors.initials: D
authors.lastname: Goga
authors.affiliation: Service de chirurgie plastique et reconstructrice, hôpital Sud, CHU de Rennes, boulevard de Bulgarie, 35200 Rennes, France.
authors.forename: E
authors.initials: E
authors.lastname: Watier
authors.affiliation: Service de chirurgie plastique et reconstructrice, hôpital Sud, CHU de Rennes, boulevard de Bulgarie, 35200 Rennes, France; Inserm U917, université de Rennes 1, 35033 Rennes, France; Laboratoire SITI, établissement français du sang Bretagne, CHU de Rennes, 35033 Rennes, France; STROMAlab, UMR5273 CNRS/UPS/EFS - Inserm U1031, hôpital Rangueil, 31059 Toulouse, France.
authors.forename: N
authors.initials: N
authors.lastname: Bertheuil
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000601:surgery; D005148:Facial Dermatoses / Q000175:diagnosis* / Q000601:surgery; D018934:Fournier Gangrene / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D035583:Rare Diseases; D012086:Reoperation; D013130:Spinal Stenosis / Q000150:complications; D013290:Streptococcal Infections / Q000175:diagnosis / Q000601:surgery; D000070099:Streptococcus gallolyticus; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cellulite; Cellulitis; Cervico-facial; Fournier's disease; Fournier's gangrene; Gangrène de Fournier; Gangrène périnéale; Gangrène périnéo-fessière; Mediastinitis; Médiastinite