Myelodysplastic syndrome diagnosed on the occasion of Fournier's gangrene.
Fournier's gangrene (FG) is a fulminant infective necrotizing fasciitis, which includes the genital, perineal, and perianal regions. A 77-year-old man had previously been diagnosed as having diabetes mellitus (DM) and was treated with pioglitazone (15 mg) and miglitol (150 mg). He developed sudden perineal discomfort, fever with painful penile, and scrotal edema, subsequently leading to urinary retention. According to physical examination and CT scan results for the swollen penis and scrotum, he was diagnosed with FG. FG was eventually controlled by extensive treatment with broad spectrum antibiotics and repeated surgical debridement including penectomy and scrotectomy. He showed persistent anemia and decreased neutrophils exhibiting hypogranulation. Bone marrow aspiration revealed hypercellularity with 9% myeloblasts, micromegakaryocytes, abnormal leukocyte granulation, and erythrocytic dyspoiesis, leading to a diagnosis of myelodysplastic syndrome (MDS) RAEB-1, and he was evaluated as high risk according to IPSS-R. After 4 courses of azacitidine treatment, he achieved HI-E and had no further recurrence of FG for more than 18 months. Although DM and alcohol misuse are common systemic comorbidities in patients with FG, MDS should be considered in elderly FG cases, even when DM complications are present.
Hematology Division, JCHO Sapporo Hokushin Hospital.
Masaaki
M
Adachi
Kimiyoshi
K
Mitsuhashi
Hiroyuki
H
Matsuda
Junko
J
Watanabe
Katsuya
K
Nakanishi
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018934:Fournier Gangrene / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000188:drug therapy*; D000077205:Pioglitazone; D012008:Recurrence; D045162:Thiazolidinediones / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone