Fournier's Gangrene in a Patient Receiving Treatment for Idiopathic Thrombocytopenic Purpura

Abstract

We report the case of a 68-year-old man who was diagnosed with Fournier's gangrene (FG), which developed during immunosuppresive treatment for idiopathic thrombocytopenic purpura (ITP). The patient was administered steroids for ITP but on the 36th day, he developed FG and septic shock. We initiated antibiotic treatment and drained a periproctal abscess immediately. On day 53, extensive drainage to progressive FG and a splenectomy was performed, following which both FG and thrombocytopenia improved. This is the first case of FG has developing in a ITP patient. It appears that high-dose immunoglobulin therapy and splenectomy should be considered earlier especially for a patient complicated with FG.

Perineal Gas Gangrene: Two Cases Report and Review of the Literature

“…The most common predisposing factors are diabetes mellitus and alcohol abuse [1,[5][6][7][8][9].In a review of 1726 cases, published in the literature, diabetes mellitus was a factor in 20% [1]. Others important predisposing factors include indwelling catheters, localized trauma, surgical procedure, malignancy, steroids, chemotherapy and human immunodeficiency virus [9][10][11][12][13].…”

“…The most commonly found bacteria are Escherichia Coli, followed by Bacteriodes and Streptococcal species. Other bacteria involved include Staphylococcus, Enterococcus, Clostridium, Pseudomonas, Klebsiella and proteus species [1,8,10,14].…”

“…Early diagnosis and aggressive management are essential as overwhelming sepsis may quickly develop and is associated with a significant mortality rate reported as 16% in the Meta analysis of Eke [1]. The Fournier's gangrene severity index (FGSI) score is a numeric score proposed by Laor et al in 1995 to prognosticate on the outcome of the disease [4,10,[21][22]. It is obtained from a combination of admission physiologic parameters, including temperature, heart and respiration rates, sodium, potassium, creatinine, WBC counts, hematocrit, and sodium bicarbonates.…”

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

“…In the first case, a 68-year-old man with diabetes mellitus who was diagnosed with IT and treated with steroids and high-dose Ig without response. On day +36 he developed FG of perineal abscess 46. Klebsiella pneumonia was cultured from the patient’s blood and necrotizing tissue.…”

“…Klebsiella pneumonia was cultured from the patient’s blood and necrotizing tissue. The second one was an otherwise healthy 66-year-old man, in which steroids and high-dose immunoglobulins were given with complete recovery of thrombocytopenia 46. However, on day +34, while on tapering steroids, FG developed as a consequence of perineal abscess.…”