BACKGROUND Sodium glucose co-transporter 2 (SGLT2) inhibitors have become an appealing treatment for diabetes due to their favorable cardiac and renal outcomes. However, reports continue to emerge ...describing potentially life-threatening adverse events such as Fournier's gangrene and diabetic ketoacidosis associated with their use. Herein, we present a case of simultaneous Fournier's gangrene and diabetic ketoacidosis after initiation of treatment with canagliflozin. CASE REPORT A 37-year-old female with diabetes presented to the hospital with a chief complaint of left gluteal pain associated with dysuria 1 month after canagliflozin was added to her regimen. On initial evaluation, the patient was afebrile and hemodynamically stable. Physical examination revealed suprapubic tenderness and induration in the left gluteal region extending to the perineum. Laboratory testing was significant for anion gap metabolic acidosis with the presence of serum ketones. Computed tomography of abdomen and pelvis revealed features suggestive of Fournier's gangrene. The patient was treated for Fournier's gangrene and diabetic ketoacidosis. Management included empirical antibiotic treatment, multiple surgical explorations with debridement as well as insulin infusion with aggressive fluid resuscitation. The patient was discharged with a urinary catheter, vacuum dressing, and colostomy with instructions to start a basal bolus insulin regimen and discontinue canagliflozin. CONCLUSIONS This is the first case describing a simultaneous occurrence of Fournier's gangrene and diabetic ketoacidosis with SGLT2 inhibitor therapy. Considering the growing popularity of these drugs, it is important to be aware of their more serious and potentially fatal complications. It is also important to promptly terminate SGLT2 inhibitors when harmful adverse effects are suspected.
AIM:To determine the significance of enterostomy in the emergency management of Fournier gangrene.METHODS:The clinical data of 51 patients(49 men and 2 women)with Fournier gangrene who were treated ...at our hospital over the past 12 years were retrospectively analyzed.The patients were divided into two groups according the surgical technique performed:enterostomy combined with debridement(the enterostomy group,n=28)or debridement alone(the control group,n=23).Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery,as well as administration of broad-spectrum antibiotics.The clinical data and outcomes in both groups were analyzed.RESULTS:The surgical procedures were successful in both patient groups.In the enterostomy group,10 (35.8%)patients required skin grafting with a total of six debridement procedures.While in the control group,six(26.1%)patients required four debridement procedures.However,this difference was not statistically significant.Following surgery,the time to normal body temperature(6 d vs 8 d,P<0.05)and average length of hospital stay(14.3±7.8 d vs 20.1±8.9 d,P<0.05)were shorter in the enterostomy group.The case fatality rate was lower in the enterostomy group than that in the control group(3.6%vs 21.7%,P<0.05).CONCLUSION:Enterostomy can decrease the case fatality rate of patients with Fournier gangrene.
Diabetes mellitus is a disease characterized by chronic hyperglycaemia due to an absolute or relative lack of insulin. The disease mainly affects the nervous system, and the urological complications ...themselves develop on the basis of these disorders. Urological patients with diabetes present in ambulance with manifestations of common urological diseases, but also suffer from complications of the urinary system or genital organs that are specific for diabetic patient. Usually, these complications go unrecognized for a long time or manifest only non-specifically. But they are often life-threatening for patients. Treatment does not consist only in urological stabilization, but stabilization of the diabetes itself is also necessary. It can be said that diabetes increases the risk of urological problems, and on the contrary, urological problems (especially inflammation) can lead to decompensation of the patient's diabetes.
Many predictive factors and scoring systems associated with Fournier's gangrene have been proposed, including comorbidities, vital signs, biochemical and hematological parameters, and demographic ...characteristics of the patient. The aim of this study was to determine the strengths of the scoring systems that have been formed by revealing these factors from a wider perspective and in a larger patient population.
The patient population included 144 patients, 21 of whom died. Age, biochemical and hematological parameters, Uludag Fournier's Gangrene Severity Index (UFGSI), Fournier's Gangrene Severity Index (FGSI), and Age-Adjusted Charlson Comorbidity Index (ACCI) scores were analyzed using the Mann Whitney U-test due to their non-parametric distribution. Categorical data such as comorbidities, gender, need for positive inotropes, diversion ostomy status, and UFGSI grading status was analyzed with the Chi-square test, and independent risk factors were determined from the significant data emerging from univariate and multivariate logistic regression analysis. Their strengths were compared using the logistic regression model (Fournier's Gangrene Mortality Prediction Model: FGMPM) created through ROC analysis of the FGSI, UFGSI, and ACCI scores.
The results of the statistical analyses showed that albumin (p<0.001) and need for positive inotropic support (p<0.001) were independent risk factors for mortality and ROC analysis revealed that the created FGMPM regression model (AUC: 0.995) was a stronger model than the FGSI (AUC: 0.874), UFGSI (0.893), and ACCI (0.788) scoring systems.
The results of this study revealed that albumin and the need for positive inotropic support are independent risk factors for mortality. It is thought that the determination of these two parameters can be used to predict mortality more practically than the parameters used in the UFGSI and FGSI.
Prognostic factors in Fournier gangrene Ruiz-Tovar, Jaime; Córdoba, Luis; Devesa, Jose Manuel
Asian journal of surgery,
2012, January 2012, 2012-Jan, 2012-01-00, 2012-01-01, Letnik:
35, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Summary Background Fournier gangrene is a necrotizing fasciitis, arising in the genital and perineal area. This entity is still associated with a high mortality rate despite improvements in ...antibiotic and surgical treatment. Methods This is a retrospective study of all the patients diagnosed and surgically treated for Fournier gangrene at General University Hospital Ramon y Cajal between 1988 and 2008. Possible prognostic factors that could have any influence on the evolution of Fournier gangrene were analyzed. Results Seventy patients were analyzed, 62 males (88.6%) and 8 females (11.4%) with a mean age of 57.9 ± 13.5 years. Most frequent clinical manifestations were perineal pain (82.9%) and fever (60%). Physical examination revealed edema (91.4%), erythema (88.6%) and perineal skin necrosis (60%). All the patients underwent surgical debridement of necrotic tissue. In 54.3% reoperations were necessary for new surgical debridements. Medical complications rate was 27.1% and mortality one 22.9%. Ethylism, coexistence of neoplasms, presence of skin necrosis, myonecrosis, abdominal wall affection, number of debrided areas, reoperations, concentration of creatinine in serum>1.4 mg/dL, and hemoglobin <10 g/dL, and platelet count <150 × 109 /L in whole blood are associated with higher mortality rates. Conclusion Identification of prognostic factors may help to determine high-risk patients in order to establish an optimal treatment, according to severity of the infection and general status.
We report the first case of Fournier's gangrene caused by three unusual anaerobic organisms: Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi. The infection occurred in a ...73-year-old man without typical risk factors for the development of Fournier's gangrene. Clinical outcome was good after prolonged antibiotic treatment and extensive debridement of the perineum. The case suggests that A. funkei, F. gonidiaformans and C. hathewayi should be considered as potential pathogens of Fournier's gangrene. Human infections caused by these organisms are very rare but can be underestimated because correct identification is very difficult, especially in polymicrobial infections such as Fournier's gangrene.
•Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi should be considered as potential pathogens of Fournier's gangrene.•Human infections caused by these organisms are very rare but can be underestimated.•Correct identification of these organisms is very difficult, especially in polymicrobial infections such as Fournier's gangrene.
Fournier's gangrene is a rare, rapidly progressive, fulminant form of infective necrotising fasciitis of the genital, perianal and perineal regions. We present a case of Fournier's gangrene of the ...penis complicating acute genital ulceration and recurrent paraphimosis that was secondary to contemporaneous COVID-19 and Mpox infection in an otherwise healthy 41-year-old man. It is important for clinicians to be aware of Fournier's gangrene, as early detection remains the cornerstone of effective tissue and indeed life conserving management.
Fournier ’ s gangrene in an older woman Huang, Yu-Hsiang; Lin, Yu-Wei; Ho, Min-Po
Asian journal of surgery,
July 2023, 2023-07-00, 2023-07-01, Letnik:
46, Številka:
7
Journal Article
Fournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial ...organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species.
We report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG.
FG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.
We present here the first case of successful management via preoperative ultrasonographic (US) study to detect a distant spreading of Fournier's gangrene (FG), which was happened in a 75-year-old ...man. US study showed the necrotizing infection in the periumbilical region distant 22 cm from the genital tract. A target incision of this periumbilical area and debridement of necrotic tissues was made. Computed tomography (CT) is superior to ultrasonography to confirm the diagnosis of FG and support in surgical management, but a CT evaluation in patients with FG may be limited by the frequent presence of concurrent acute renal failure or patient hemodynamic instability. Ultrasonography is an ideal technique for evaluating patients in bedside settings and can be routinely used in an emergency.
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