Acute Gangrene of the Scrotum and Penis in a Patient with Acute Promyelocytic Leukemia

Patrizi, Annalisa; Bandini, Giuseppe; Cavazzini, Giovanna; F, Sommariva; Veronesi, S.

doi:10.1159/000249770

Cited by 12 publications

(7 citation statements)

References 3 publications

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“…The disease has rarely been described in adults with leukemia. Twelve cases of FG complicating the postchemotherapy aplastic phase for hematologic malignancies have been described by various authors [5][6][7][8][9][10][11]. In most cases P. aeruginosa was the responsible pathogen and the infection occurred during periods of profound neutropenia.…”

Section: Discussionmentioning

confidence: 99%

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Fatal Fournier's gangrene in a young adult with acute lymphoblastic leukemia

Mantadakis

Pontikoglou

Papadaki

et al. 2006

Pediatric Blood & Cancer

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Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the external genitalia. Few reports of FG exist in patients with hematologic malignancies. We describe a case of fatal FG in a 21-year-old man with acute lymphoblastic leukemia who was receiving remission-induction chemotherapy. Despite early local surgery, administration of appropriate antibiotics, resurgery for wider debridement and aggressive ICU support he succumbed while pancytopenic to septic shock, 26 days after initiation of chemotherapy. Multi-drug resistant Pseudomonas aeruginosa was isolated from blood and scrotal cultures obtained at initial surgery. FG is a fulminant infection, especially in the face of profound cytopenias.

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Section: Discussionmentioning

confidence: 99%

“…Well-documented reports of FG in patients with hematologic malignancies are limited mostly to patients with acute myelogenous leukemia (AML) [4][5][6][7][8][9][10][11]. Hence, our current report of a 21-year-old man with acute lymphoblastic leukemia (ALL) who developed fatal FG during remission-induction chemotherapy is instructive.…”

Section: Introductionmentioning

confidence: 94%

Fatal Fournier's gangrene in a young adult with acute lymphoblastic leukemia

Mantadakis

Pontikoglou

Papadaki

et al. 2006

Pediatric Blood & Cancer

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“…[1][2][3][4][5][6]8,[10][11][12] The first case of Fournier's gangrene associated with a hematological disease was described in 1983 by Patrizi et al They reported one case of acute promyelocytic leukemia treated by conventional chemotherapy. 11 Seven other patients with hematological malignancies have subsequently been reported; 8,12 they suffered from ANLL (three cases), ALL (two cases) and NHL (two cases). One, suffering from NHL in first relapse, had undergone auto-BMT and died of sepsis on day + 6 ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…2,4,6,10 It was isolated in five out of seven patients with hematological malignancies. 8,11,12 In the majority of cases, Fournier's gangrene involves mixed bacterial flora: 3 the infection is caused by aerobic and anaerobic organisms with low or moderate virulence. Anaerobic organisms were not identified by culture, but their presence should be suspected where crepitation is present.…”

Section: Discussionmentioning

confidence: 99%

Fournier’s gangrene: a clinical presentation of necrotizing fasciitis after bone marrow transplantation

Martinelli

Alessandrino

Bernasconi

et al. 1998

Bone Marrow Transplant

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Summary:Three patients with ANLL developed Fournier's gangrene as an early complication after allo-BMT (two cases) and auto-BMT (one case); two patients were in first CR, the third had resistant disease. Patients developed fever, perineal pain, swelling and blistering of the genital area. Pseudomonas aeruginosa was isolated from the lesions and patients received systemic antibiotic therapy, surgical debridement and medication with potassium permanganate solution. Two patients made a complete recovery although one died of sepsis. The third had progressive involvement of the abdominal wall and later died of leukemia. Early diagnosis of this disorder and prompt initiation of appropriate therapy can prevent progression of this acute necrotizing infection. Keywords: Fournier's gangrene; necrotizing fasciitis; bone marrow transplantation Fournier's gangrene (FG) is an acute severe necrotizing disease of the fascia, subcutaneous fat and skin caused by a combination of aerobic and anaerobic bacteria, and involves the lower parts of the genitourinary tract, anorectal soft tissue and genital skin. 1-5 Fournier's gangrene usually involves male genitalia, but it has also been described in females. 2,3 Schultz et al 6 suggest that Fournier's gangrene may be related to a form of localized vasculitis with histological evidence of hemorrhagic necrosis. A mortality rate of 30-50% has been reported; 2,3,6 predisposing factors include diabetes mellitus, perineal trauma or infection, chronic alcoholism, malignancies and an immunocompromised status. 3 Despite the severe immunodeficiency that occurs in patients who undergo bone marrow transplantation (BMT), 7 Fournier's gangrene has been described in only one case of autologous BMT (auto-BMT). 8 We report three further cases who developed FG in the early cytopenic post-transplant phase. Two had received an allogeneic BMT (allo-BMT); the third an auto-BMT; all were suffering from acute non-lymphocytic leukemia (ANLL). Case reports Case No. 1A 41-year-old male, with ANLL in first hematological complete remission (CR), underwent allo-BMT from an HLA identical sibling donor. Pre-transplant tests showed normal renal and hepatic function; chest X-ray revealed evidence of a previous right pleuritis; ECG and echocardiography were normal. Performance status was good and clinical examination was negative. Conditioning consisted of busulphan (BU) and cyclophosphamide (CY). The patient received 2 × 10 8 /kg donor bone marrow cells; take was documented on day +11 from transplant. On day +4, he complained of chills and fever Ͼ38°C; physical examination showed genital erythema, pain, swelling and crepitation. Broad-spectrum systemic antibiotic therapy was started; white blood cell (WBC) and platelets counts were respectively 0.5 × 10 9 /l and 0.1 × 10 9 /l. Cultures from the central venous catheter (CVC) were positive thereafter for Staphylococcus aureus. On day +10 the cutaneous genital lesions worsened with blistering and ulceration. The patient developed scrotal gangrene (Figure 1) involving the...

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“…19–40 The mean age was 35 years (range 6–83 years). Thirty (86%) patients were male, while only 3 patients (14%) were female.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

Fournier's Gangrene Complicating Hematologic Malignancies: Literature Review and Treatment Suggestions

D’Arena

Pietrantuono

Buccino

et al. 2013

Mediterr J Hematol Infect Dis

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Fournier’s gangrene (FG) is a rare but severe necrotizing fasciitis of the external genitalia that may complicate the clinical course of hematologic malignancies and sometimes may be the first sign of the disease. The clinical course of FG is very aggressive and the mortality is still high despite the improvement in its management. Early recognition of FG and prompt appropriate treatment with surgical debridement and administration of antibiotics are the cornerstone of the management of this very severe disease. A review of the scientific literature focusing on the topic of FG complicating hematologic disorders is reported

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Acute Gangrene of the Scrotum and Penis in a Patient with Acute Promyelocytic Leukemia

Cited by 12 publications

References 3 publications

Fatal Fournier's gangrene in a young adult with acute lymphoblastic leukemia

Fatal Fournier's gangrene in a young adult with acute lymphoblastic leukemia

Fournier’s gangrene: a clinical presentation of necrotizing fasciitis after bone marrow transplantation

Fournier's Gangrene Complicating Hematologic Malignancies: Literature Review and Treatment Suggestions

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