Case Report

Group C Streptococcal Sepsis Complicating Fournier Gangrene

Authors: Mark A. Marinella, MD, FACP, CNSP, FACN, FACGS

Abstract

Fournier gangrene is a life-threatening necrotizing fasciitis of the perineal-scrotal area that occurs in diabetic males. Patients typically present with systemic toxicity and significant inflammatory changes in the scrotum and perineum. Most cases of Fournier gangrene are polymicrobic and require urgent surgical débridement and broad-spectrum antibiotic therapy. We describe a case of Fournier gangrene in a young diabetic man that was associated with group C streptococcal bacteremia, an association previously unreported in the literature to our knowledge.


Key Points


* Diabetic patients may present with infections unique to this population, which include rhinocerebral mucormycosis, emphysematous cholecystitis, malignant otitis externa, and Fournier gangrene.


* Fournier gangrene is a form of necrotizing fasciitis involving the perineum and scrotum that affects diabetic men with poor glycemic control.


* Typical signs and symptoms of Fournier gangrene include perirectal, perineal, and scrotal pain and swelling, as well as fever.


* Most cases of Fournier gangrene are polymicrobic, but isolating group C streptococci should not dissuade the clinician from the diagnosis.


* Infections due to group C streptococci should be treated with a β-lactam agent and if a drainable focus is present, surgery or percutaneous drainage should be performed.

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