Fournier's Gangrene Associated with Local Cutaneous HPV Lesions in a Previously Healthy Girl

Maria Tsinti,Ioannis Vlachakis,Theophani Tsekoura,Evangelos Blevrakis,Amalia Tsilimigaki-Christaki

doi:10.1155/2013/704532

Abstract

A case of an 11-year-old prepubertal girl with Fournier's gangrene is presented. The diagnosis was posed after the disease had progressed to the typical clinical picture of frank gangrene. A benign viral infection, common warts, possibly represents the initiating event of the development of this necrotizing soft tissue infection. The development of childhood Fournier's gangrene in association with viral infections has been reported in the past. An optimal outcome was achieved by aggressive antibiotic and surgical treatment despite the late diagnosis. In children, Fournier's gangrene develops in previously healthy individuals with benign diseases often representing the initiating events; thus, high index of suspicion is necessary for an early diagnosis that will lead to the optimal outcome.

Highlights

Fournier’s gangrene (FG) is a potentially fatal necrotizing soft tissue infection of the perineal region
The diagnosis of FG was posed after the disease had progressed to the typical clinical picture of frank gangrene and was further supported by the laboratory investigation; the typical ultrasonographic findings, the common but unspecific finding of elevated infectious markers and the coagulopathy, a hallmark of childhood necrotizing soft tissue infections which is often helpful in the differentiation from nonnecrotizing infections [7]
The patient had already been previously examined in the third and fourth days of illness but the existence of a necrotizing soft tissue infection had not been suspected, as apparently the necrotic lesions had not extended to the superficial layers of the skin by that time

Summary

Introduction

Fournier’s gangrene (FG) is a potentially fatal necrotizing soft tissue infection of the perineal region. FG, initially described as a disease of young males, is known to affect both sexes and all ages; the greatest incidence is observed among middle-aged immunocompromised men [2] It represents a very rare clinical entity in childhood, and the majority of cases have been described in infants [3]. Most pediatric cases of FG have been reported in previously healthy children, who may appear well in the early course of the disease and, may escape diagnosis [1, 5]. Predisposing factors such as local trauma and infections, including viral infections, have been described in childhood FG [6]. We describe this clinical case to emphasize on the meticulous clinical examination and the high index of suspicion, necessary for the early diagnosis and prompt intervention in FG, and on the necessity of aggressive medical and surgical treatment for the optimal outcome

Case Presentation

Discussion