Endocrine Abstracts

JOINT1726

Introduction: Fournier’s gangrene is a rare and serious bacterial infection of the external genitalia and perineum, causing skin destruction. It generally affects men with a history of immunodepression. It is a medico-surgical emergency due to its rapid evolution, which can lead to sepsis and death. Treatment combines surgical intervention and appropriate antibiotic therapy. We report the case of a patient admitted for diabetic ketosis on Fournier gangrene.

Observation: A 60-year-old patient, diabetic (type 2) 6 years previously, was admitted for management of diabetic ketosis. He presented with a polyuro-polydipsic syndrome with pain in the anal region evolving in a context of chills. Examination revealed a red, warm, painful and indurated swelling on the left perianal area. Biological examination revealed an infectious syndrome with elevated WBC and CRP. Ultrasound of the anal soft tissues revealed extensive infiltration of the subcutaneous and fascial soft tissues, with micro-logetes in the process of collection. Fournier’s gangrene was diagnosed on the basis of necrosis of the subcutaneous tissues. Management consisted of surgical debridement, excision of necrotic tissue and drainage, combined with triple antibiotic therapy. Post-operative management was straightforward. On improving, the patient was referred to the plastic surgery department for skin reconstruction.

Discussion/conclusion: Despite its rarity, Fournier’s gangrene remains a formidable disease due to its serious complications, and is particularly common in diabetic patients. Diagnosis is mainly clinical. Treatment involves emergency surgical debridement with appropriate antibiotic therapy. Plastic surgery techniques can be used to improve aesthetics. Prognosis is closely linked to rapid diagnosis and intervention.