Fournier's gangrene complicating aggressive therapy for hematologic malignancy

Berg, Alan R.; Armitage, Jamés O.; Burns, C. Patrick

doi:10.1002/1097-0142(19860615)57:12<2291::aid-cncr2820571210>3.0.co;2-4

Cited by 55 publications

(21 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, Fournier’s gangrene has been reported as a presenting feature of diabetes [ 16]. Immunosuppression, either after organ transplantation [ 17] or caused by chemotherapy for malignant disease, [ 18, 19] is also associated with an increased risk. Since the emergence of HIV infection, a new group of patients at risk has been recognized in both Africa and the developed world [ 20–23], and Fournier’s gangrene has been reported as a presenting sign of undiagnosed HIV infection [ 22].…”

Section: Definition and Aetiologymentioning

confidence: 99%

Fournier’s gangrene

Smith

Bunker

Dinneen

1998

British Journal of Urology

276

228

View full text Add to dashboard Cite

Section: Definition and Aetiologymentioning

confidence: 99%

Fournier’s gangrene

Smith

Bunker

Dinneen

1998

British Journal of Urology

276

228

View full text Add to dashboard Cite

“…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).…”

Section: Discussionmentioning

confidence: 89%

“…[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%

See 1 more Smart Citation

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

Martinelli

Alessandrino

Bernasconi

et al. 1998

Bone Marrow Transplant

View full text Add to dashboard Cite

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...

show abstract

“…He had two well-described risk factors: i.e., NIDDM [12] and chemotherapy for acute leukemia [4,12]. It may be asked whether ATRA played a role in the occurrence of this gangrene.…”

Section: Discussionmentioning

confidence: 99%

Fournier's gangrene during induction treatment of acute promyelocytic leukemia, a case report

Lévy

Jaffarbey

Aouad

et al. 1998

Annals of Hematology

View full text Add to dashboard Cite

Fournier's gangrene is described as a fulminant necrotizing fasciitis of the scrotum and penis. Few cases have been reported in the context of acute leukemia. We describe a case, complicating the induction treatment of an acute promyelocytic leukemia with all-trans-retinoic acid and chemotherapy. The evolution was favorable, following surgical excision and broad-spectrum antibiotic therapy. The respective roles of all-trans-retinoic acid and granulocytopenia are discussed. This devastating and life-threatening infection must be kept in mind for early clinical, bacteriological, and radiological diagnosis and surgical management.

show abstract

Fournier's gangrene complicating aggressive therapy for hematologic malignancy

Cited by 55 publications

References 15 publications

Fournier’s gangrene

Fournier’s gangrene

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

Fournier's gangrene during induction treatment of acute promyelocytic leukemia, a case report

Contact Info

Product

Resources

About