A CASE OF FOURNIER'S GANGRENE WITH SHOCK AND AGRANUROCYTOSIS

Abstract

A case of Fournier's gangrene with agranurocytosis is reported. A 65-year-old male had a fever, sore throat and general fatigue about a week after perianal pain. Though he received medical treatment for 3days as a common cold, he went to a state of shock and fained. On admission, WBC count was 700/mm3 and DBC showed agranurocytosis. On hospital day 2 WBC count further decreased to 300/mm3 and platelet count also decreased to 2.8×104/mm3 from 10.8×103 at the day of admission. No neutrophiles were recognized in the bone marrow. Internal medicine or sepsis might induce maturatin arrest. Severe inflammation was recognized in the left gluteal region and scrotum. CT scan showed diffuse gas shadows in the left gluteal subcutaneous region. Local incision and drainage at the region were performed. E. coli was detected from incised site. On a follow up CT on the 4th HD, most of the gas shadow disappeared dramatically. However, inflammation progressed and a part of the scrotum and right gluteal region fell to necrosis. Additional incisions were performed. After the incisions his general condition began to improve. Though respiratory distress and delirium due to sepsis were recognized from an early stage, the patient well responded to the intensive care, and was discharged from the hospital on the 97th HD, when he went home on foot.