Abstract
Fournier’s gangrene (FG) is an atypical, life-threatening polymicrobial infection characterized by the rapid destruction of soft tissue, predominantly in the perineal region. Retroperitoneal spread of FG represents an uncommon condition described in a few case reports, and its presentation as the first manifestation of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is even more infrequent. Here, we present the case of a 40-year-old male who was admitted to the emergency department with a low-grade fever of 37.8°C, abdominal pain, and four-day history of sharp, bilateral testicular pain and swelling. On physical examination, the patient was hypotensive with necrotic tissue in the perineum. A computed tomography study displayed an extensive retroperitoneal spread of suspected FG. Due to the massive spread of the infection, an HIV test was requested, yielding positive results, which indicated that HIV/AIDS had first manifested as FG with retroperitoneal extension. This is an extremely rare initial presentation of HIV/AIDS. To treat the patient and address the severe necrosis, a peritoneal lavage, surgical debridement, right orchiectomy, and colostomy were performed. After the procedure, antiretroviral therapy was established with tenofovir, emtricitabine, and efavirenz.
Highlights
Fournier’s gangrene (FG) is an atypical, life-threatening polymicrobial infection caused mainly by Escherichia coli, Klebsiella, Staphylococcus aureus, Streptococcus, and anaerobes
We present an even more infrequent description of FG as the first manifestation of the human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) and its successful management
We report the presence of FG with retroperitoneal involvement serving as the first manifestation of HIV/AIDS [5]
Summary
Fournier’s gangrene (FG) is an atypical, life-threatening polymicrobial infection caused mainly by Escherichia coli, Klebsiella, Staphylococcus aureus, Streptococcus, and anaerobes. Multiple emphysema foci spreading from the genital area (white arrow) to the peritoneum (orange arrows). These findings are consistent with an intraperitoneal extension of FG. The patient’s acute presentation and CT findings indicated an emergency explorative laparotomy This procedure revealed that the FG was severe and had spread to the peritoneal and retroperitoneal space. A right orchiectomy was performed and all the devitalized tissue was removed in the perineum (white arrows) and scrotum (orange arrows). The hospital’s plastic surgery team evaluated the patient’s condition and performed a primary intention closure in the scrotum and a secondary intention closure of the debrided area in the perineum on postoperative day 15 (Figure 5). Erectile function and ejaculation were preserved, and the cosmetic outcome was satisfactory
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