Presentation
We present two patients of TA who presented with gangrene of extremities, and review eight prior such patients reported in the literature. [ncbi.nlm.nih.gov]
Presentation Gangrene can affect any part of the body but most often affects the extremities, ie the fingers and toes. Gangrene can also affect the internal body organs, particularly the gastrointestinal tract. [patient.info]
Immune System
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Inguinal Lymphadenopathy
Perineal examination revealed grossly swollen and indurated scrotum with bilateral inguinal lymphadenopathy. Investigations showed elevated inflammatory markers and HbA1c of 99 mmol/mol (11.2%). [ncbi.nlm.nih.gov]
Right inguinal lymphadenopathy (black arrow) is also noted. Ultrasonography A US finding in Fournier gangrene is a thickened, edematous scrotal wall. [doi.org]
Entire Body System
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Enuresis
In anecdotes, Fournier described recognized causes of perineal gangrene, including placement of a mistress’ ring around the phallus, ligation of the prepuce (used in an attempt to control enuresis or as an attempted birth control technique practiced by [emedicine.medscape.com]
Workup
Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options and morbidity-mortality rates of Fournier's gangrene are reviewed, emphasizing the role of immunosuppression in renal transplant recipients to disease development [ncbi.nlm.nih.gov]
(see Clinical and Workup). They require aggressive treatment to combat the associated high morbidity and mortality (see Treatment). Images of necrotizing fasciitis are shown below. [emedicine.medscape.com]
Urine
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Glycosuria
Sodium-glucose cotransporter 2 (SLGT2) inhibitors has been associated with an increased risk of genital infections secondary to increased glycosuria. [ncbi.nlm.nih.gov]
Treatment
If treatment is delayed, the gangrene is extensive, or the person has other significant medical problems, the person may die. [nlm.nih.gov]
However, because of the nature of this type of treatment, many people are reluctant to try it. [nhs.uk]
Any delay in treatment can dramatically increase mortality. [ncbi.nlm.nih.gov]
Prognosis
Prognosis Prognosis depends on the presence of other morbidity, the area of the body affected and the extent of gangrene. One quarter of patients will develop septic shock which has a high fatality rate. [patient.info]
PURPOSE: For survivors of perineal gangrene (PG), quality of life and functional prognosis of pelvic functions are probably overestimated. [ncbi.nlm.nih.gov]
What is the prognosis for wet gangrene? Prognosis in wet gangrene depends on the extent of disease, the underlying cause and the timing of appropriate treatment. [dermnetnz.org]
Gas gangrene has the worst prognosis. It is associated with a high death rate because it causes the infection to quickly spread to the bloodstream. References: Lipworth AD, et al., eds. [docdoc.com.sg]
Etiology
The usual etiology of hypernatremic dehydration in this age group is insufficient breast milk intake. [ncbi.nlm.nih.gov]
Trauma is the most common etiology. Nonpalpable pulses are common. Palpable pulses do not preclude the presence of limb-threatening ischemia. [accessmedicine.mhmedical.com]
Other rare etiologies, such as diabetes mellitus, carbon monoxide poisoning, and plastic surgery, have also been reported as related to this illness. [scienceopen.com]
Gas gangrene is also called 'Clostridial myonecrosis' because Clostridium species are the most common etiologic agents (cause). [doi.org]
Solitary Candida albicans Infection Causing Fournier Gangrene and Review of Fungal Etiologies. Rev Urol. 2014. 16 (2):95-8. [Medline]. Jaworski R, Irga-Jaworska N, Naumiuk Ł, Chojnicki M, Haponiuk I. [emedicine.medscape.com]
Epidemiology
Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options and morbidity-mortality rates of Fournier's gangrene are reviewed, emphasizing the role of immunosuppression in renal transplant recipients to disease development [ncbi.nlm.nih.gov]
"Fournier's gangrene: Population based epidemiology and outcomes". The Journal of Urology. 181 (5): 2120–6. doi:10.1016/j.juro.2009.01.034. PMC 3042351. PMID 19286224. [en.wikipedia.org]
[…] presents as symmetrical gangrene of two or more extremities without large vessel obstruction or vasculitis. [ 2 ] Fournier's gangrene is a rare but severe necrotising fasciitis of the external genitalia. [ 3, 4 ] Other forms of necrotising fasciitis. [ 5 ] Epidemiology [patient.info]
Epidemiological characteristics of Fournier's gangrene: a report of 71 patients. Urol Int. 2012;89:457-61. [ Links ] 10. Yilmazlar T, Ozturk E, Ozguc H, Ercan I, Vuruskan H, Oktay B. [scielo.br]
Pathophysiology
Designed to provide students with essential concepts of disease processes and altered health states, this text is ideal for both discrete and integrated pathophysiology courses. [books.google.com]
The hallmarks of this disease are rapid onset of myonecrosis with muscle swelling, severe pain, gas production, and sepsis. [1, 2, 3] Pathophysiology Clostridium species are gram-positive, spore-forming, anaerobic rods normally found in soil and the gastrointestinal [emedicine.medscape.com]
[…] factors in dry gangrene There are different pathways involved in the pathophysiology of dry gangrene (Figure 1). [dovepress.com]
Prevention
Treatment for gangrene involves removing the affected tissue, preventing infection or treating any existing infection, and treating the problem that led to gangrene developing. [nhs.uk]
In general, dead tissue should be removed to allow healing of the surrounding living tissue and prevent further infection. [nlm.nih.gov]