BACKGROUND
Fournier's gangrene is an idiopathic form of
necrotizing fasciitis involving the genital and perineal regions; it is associated with high complication and mortality rates. Rarely, perineal
infection may be caused by hospital-acquired antimicrobial-resistant bacteria. This report is of a 30-day-old infant with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae
necrotizing fasciitis involving the perineal region. CASE REPORT A 30-day-old male infant presented to the Emergency Department with rapidly progressive white discoloration of scrotal skin since 3 days prior to admission, progressing from 2-3 white spots to covering two-thirds of the scrotal skin.
Pain upon urination was noted, with normal appetite and bowel movements. He had a history of
diaper rash 6 days earlier accompanied by
fever, and the
rash was treated with topical antifungal and
corticosteroid ointment. He was born at term by caesarean delivery, with
birth weight 2900 g. Laboratory examinations revealed leukocyte count 23 000/µL and CRP 26.8 mg/dL.
Hemoglobin was 10.6 g/dL, serum
sodium was 134 mEq/L,
blood glucose was 80 mg/dL, serum
urea was 15 mg/dl, and
creatinine was 0.27 mg/dL. Chest and abdominal X-rays were normal. He received broad-spectrum
antibiotics and underwent surgical
debridement, and necrotic tissue was obtained for biopsy and culture. Histology examination showed non-specific granulation tissue consistent with
Fournier gangrene. Soft- tissue culture isolated MRSA and ESBL-K.
Antibiotics were changed according to the sensitivity report. Blood and urine cultures were negative. CONCLUSIONS Immediate surgery and
antibiotics are essential in treating
Fournier gangrene to avoid life-threatening complications. Initial symptoms are non-specific. Diagnosis remains primarily clinical, confirmed by intraoperative macroscopic findings.