Abstract
Fournier’s gangrene and emphysematous pyelonephritis are rare necrotizing infections of the genitourinary system. Many cases of this rapidly progressive infection occur from abscesses and urinary tract infections; however, Fournier’s gangrene secondary to emphysematous pyelonephritis is seldom discussed in the literature. Emphysematous pyelonephritis is defined as a gas-forming, necrotizing infection of the renal parenchyma or its surrounding tissue. Emphysematous pyelonephritis has been observed in high-risk individuals, including those with poor glycemic control and urinary tract obstruction. We present a 61-year-old male with emphysematous pyelonephritis arising from a perinephric hematoma with tracking of the infection to the scrotum, resulting in Fournier’s gangrene. The perinephric hematoma most likely developed from increased intrarenal hydrostatic pressure during nephroureteral stent placement. Broad-spectrum antibiotic therapy and surgical debridement of the retroperitoneum, groin, and scrotum were performed ultimately requiring left orchiectomy. We conclude that an existing hematoma can precipitate emphysematous pyelonephritis with tracking from the retroperitoneum to scrotum, causing Fournier’s gangrene. High-risk patients with perinephric hematomas can be susceptible to this pathologic transformation.
Highlights
Fournier’s gangrene is an uncommon, frequently fatal, polymicrobial necrotizing fasciitis of the scrotum, penis, perineum, or perianal region
Fournier’s gangrene and emphysematous pyelonephritis are rare necrotizing infections of the genitourinary system. Many cases of this rapidly progressive infection occur from abscesses and urinary tract infections; Fournier’s gangrene secondary to emphysematous pyelonephritis is seldom discussed in the literature
We present a 61-yearold male with emphysematous pyelonephritis arising from a perinephric hematoma with tracking of the infection to the scrotum, resulting in Fournier’s gangrene
Summary
Fournier’s gangrene is an uncommon, frequently fatal, polymicrobial necrotizing fasciitis of the scrotum, penis, perineum, or perianal region. Risk factors for this infection include male gender, diabetes, human immunodeficiency virus (HIV), and other immunocompromised states [1]. A limited number of cases have outlined a distinct pathway of emphysematous pyelonephritis extension from the retroperitoneum to the scrotum leading to Fournier’s gangrene. How to cite this article Fink B A, Son Y, Thomas B, et al (January 25, 2022) Emphysematous Pyelonephritis From a Perinephric Hematoma Complicated by Fournier’s Gangrene: A Case Report. There has been no reported literature of gas-forming organisms developing from an existing retroperitoneal hematoma with an extension of infection to the scrotum causing Fournier’s gangrene. A follow-up CT scan was performed two months postoperatively which did not show any residual drainable collection or evidence of infection
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