title: Fournier's gangrene during ACTH therapy.
abstract: Fournier's gangrene is an infectious necrotizing fasciitis of the perineal, genital, or perianal regions and is uncommon in children. Adrenocorticotropic hormone (ACTH) is effective for the treatment of infantile spasms; however, suppression of immune function is one of the major adverse effects of this approach. We encountered a 2-month-old boy with infantile spasms that had been treated with ACTH and had developed complicating Fournier's gangrene. Strangulation of a right inguinal hernia was observed after ACTH treatment. Although surgical repair was successful and no intestinal injuries were detected, swelling and discoloration of the right scrotum developed in association with pyrexia and a severe inflammatory response. A scrotal incision revealed pus with a putrid smell. The patient was subsequently diagnosed with Fournier's gangrene complicated by septic shock and disseminated intravascular coagulation. Extensive debridement and intensive care was performed. Enterobactor aerogenes, methicillin-resistant Staphylococcus aureus, and Enterococcus faecalis were isolated from the pus. Meropenem, teicoplanin, and clindamycin were administered to control the bacterial infection. The patient was discharged from the intensive care unit without any obvious neurological sequelae. Suppression of immune function associated with ACTH therapy may have been related to the development of Fournier's gangrene in this case.
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan. Electronic address: numoto.shingo.068@mail.aichi-med-u.ac.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Numoto
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kurahashi
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Azuma
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan; Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Numaguchi
authors.affiliation: Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Kozaburo
authors.initials: K
authors.lastname: Nakahara
authors.affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Tainaka
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan.
authors.forename: Michihiko
authors.initials: M
authors.lastname: Takasu
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yamakawa
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Nago
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan.
authors.forename: Taichiro
authors.initials: T
authors.lastname: Muto
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Okumura
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use*; D018934:Fournier Gangrene / Q000150:complications / Q000188:drug therapy*; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000209:etiology
chemical_list: D006728:Hormones; D000324:Adrenocorticotropic Hormone
keywords: ACTH therapy; Fournier’s gangrene; Infant; Strangulation of inguinal hernia