ESCHERICHIA-COLI SEPSIS IN FOURNIER GANGR ENE

Fournier's gangrene is a necrotising soft-tissue infection of the scro tum and perineal region caused by gram-negative and gram-positive Ente robacteriaceae. The disease is characterised by its unique appearance, its speed of onset, and its high mortality. Case report. A 26-year-ol d male presented to the emergency room complaining of a painful, treme ndously swollen scrotum and penis (Fig. 1) that had developed within t he past 24 h. Later, slurred speech, pallor, and hypotension were reco gnised, leading to the patient's admission to the intensive care unit. Suspecting a severe internal haemorrhage, vigorous volume therapy was started using crystalloids and colloids until blood and fresh frozen plasma were available. One hour later, septic shock was presumed and t herapy augmented by IV antibiotics, tracheal intubation, and mechanica l ventilation. Despite all efforts, the patients condition deteriorate d rapidly and he died a few hours later due to multiple organ failure in septic shock. Postmortem, a perforated external hemorrhoidal node w as found to be the primary focus of sepsis. Microbiologic cultures rev ealed Escherichia coli in blood and tissue samples. Discussion. Fourni er's gangrene is a rare disease; nevertheless, its clinical picture ha s to be recognised immediately in order to provide appropriate treatme nt in time. It occurs predominantly in males after minor trauma, color ectal or urological disease, and perineal or abdominal surgery. Fourni er's gangrene usually begins with itching and pain in the scrotal regi on followed by swelling and dark-blueish discolouration of the scrotum and penis, occasionally including the lower abdominal wall. Fever and chills are usually present. The illness progresses to severe prostrat ion and septic shock with a mortality of 20%-50%. Tissue cultures most ly reveal E. coli, gram-positive enterococci, Pseudomonas, Proteus, an d various anaerobes. The treatment should include immediate radical su rgical debridement, IV administration of broad-spectrum antibiotics, a nd cardiopulmonary support. Conclusion. The dramatic course of Fournie r's gangrene requires early recognition, extensive surgical debridemen t, as well as intensive care treatment in order to prevent irreversibl e septic shock.