Fournier's gangrene: the human counterpart of the local Shwartzman phenomenon?

Abstract

To the Editor.— Fournier's gangrene of the penis and scrotum is a rare disease with a high mortality and is of unknown nature. We treated a patient successfully with high doses of prednisone, assuming that inflammatory mediators are essential for its pathophysiology. Report of a Case.— A previously healthy 39-year-old man was referred to us because of fever (39.9° C) and severe pain and swelling of the scrotum and penis. On admission the scrotum was swollen, red, and tender. The next day a bluish-black necrotic patch 3 cm in diameter was seen on the dorsum of the penis and multiple small necrotic areas developed on the scrotum. The surrounding redness and tenderness of the skin spread rapidly over the lower abdominal wall (Fig 1). Cultures of the lesions revealed Streptococcus pyogenes, Bac-teroides melaninogenicus, other Bacteroides species, peptococci, and eubacteria. Histologie findings showed erythrocyte extravasation, moderate inflammatory infiltrate with neutrophils throughout the dermis, and fibrin thrombi-occluded blood vessels.