Abstract
BackgroundFournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species.Case presentationWe report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG.ConclusionsFG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.
Highlights
Fournier’s gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions
As a facultative Gram-positive anaerobe, Actinomyces are typically found in the human genitourinary tract (A. turicensis commonly isolated from [8]), digestive tract and oral cavity, mostly causing chronic purulent inflammation [9]
Regarding the choice of antibiotics, the result of the first germiculture only suggested Actinomyces as the causative organism, it is known that most actinomycotic infections are polymicrobial [9], because some concomitant aerobes consume oxygen to make the environment more conducive to the growth and proliferation of Actinomyces and strict anaerobes
Summary
Fournier’s gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. We report a rare case of FG mixed with A. turicensis infection. For wound bed preparation of skin grafting, we gave the patient three debridements followed by NPWT (Fig. 1b).
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