www.thelancet.com Published online March 14, 2014 http://dx.doi.org/10.1016/S0140-6736(13)61098-3 1
Clinical Picture
Fournier’s gangrene complicating thrombocytopenia treated with steroids
Giovanni D’Arena, Aldo Cammarota, Pellegrino Musto
A 66-year-old man developed sudden perineal discomfort and fever with painful anal, penile, and scrotal oedema during treatment with steroids for severe thrombocytopenia of unclear origin (whether auto immune thrombocyto- penia or myelodysplastic syndrome). An anal fi stula was observed and CT scan showed emphysematous gangrene of the perineum and scrotum, with testicles suspended in this emphysematous space (fi gure A, B). Gas gangrene had also aff ected the soft tissues below the skin, causing stretching of abdominal wall up to the hypochondrium
area (fi gure C, D), as also shown by three-dimensional CT scans (fi gure E, F). Subsequently, thrombocytopenia resolved com pletely and steroids were stopped. The patient was diagnosed with Fournier’s gangrene—a life- threatening necrotising fasciitis caused by a perineal abscess with infection of the anal fi stula. The patient was successfully treated with fl uid replacement, broad- spectrum antibiotics, and debridement of necrotic tissue, followed by reconstructive surgery.
Published Online March 14, 2014 http://dx.doi.org/10.1016/
S0140-6736(13)61098-3 Onco-Hematology Department (G D’Arena MD, P Musto MD) and Radiology Unit (A Cammarota MD), IRCCS
“Centro di Riferimento Oncologico della Basilicata”, Rionero in Vulture, Italy Correspondence to:
Giovanni D’Arena,
Onco-Hematology Department, IRCCS “Centro di Riferimento Oncologico della Basilicata”, Via Padre Pio n 1, 85028, Rionero in Vulture (Pz), Italy giovannidarena@libero.it
Figure: CT scans
A B
C D
E F
