Presentation
Past medical history of diabetes mellitus, hypertension, chronic kidney disease, and peripheral artery disease presenting with perineum pain, fever, and chills after falling in shower one day ago.
Patient Data
Initial radiographic and ultrasound imaging studies did not demonstrate findings suggestive of causative disease, so the patient subsequently underwent CT of the abdomen and pelvis with IV contrast.
Axial CT with IV contrast of the perineum shows ovoid dense fluid collection within the corpus cavernosum with an overlying small air focus.
Findings are suggestive of a necrotizing soft tissue infection within the penile musculature.
Case Discussion
Clinical signs of infection with radiographic evidence of soft tissue fluid density and overlying air in the perineum suggest necrotizing mild tissue infection and is pathognomonic for Fournier's gangrene.
While Fournier's gangrene is rare, the disease is associated with significant mortality and represents a true urologic emergency, necessitating prompt recognition and diagnosis to avoid delays in treatment.
In this case, the patient's care team was immediately contacted and informed of the diagnosis once the image findings were discovered. Given broad-spectrum antibiotics, he was transferred from urgent care to the emergency department. Subsequently, he underwent urgent surgical debridement, confirming the diagnosis with >30mL of pus extracted from the site and placement of a drain.