Search Our Scientific Publications & Authors

J Urol 2020 Jun 30:101097JU0000000000001194. Epub 2020 Jun 30.

The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.

Purpose: To evaluate the prevalent microorganisms, antibiotic sensitivity patterns, and associated outcomes in patients with Fournier's Gangrene (FG).

Materials And Methods: A retrospective chart review of patients with FG was conducted between October 2011 and April 2018 at our institution. Univariate analysis was performed using independent t-test or Kruskal-Wallis H test for continuous variables and exact test for categorical variables. Read More

Clin Case Rep 2020 Jun 20;8(6):1044-1047. Epub 2020 Mar 20.

Department of Surgery National University of Science and Technology Bulawayo Zimbabwe.

Diabetes mellitus may present for the first time with necrotizing fasciitis. Early treatment of septic shock and immediate surgical debridement reduces mortality. A diverting loop colostomy prevents soiling of extensive postdebridement wound. Read More

Urology 2020 Jun 9. Epub 2020 Jun 9.

The Ohio State University Wexner Medical Center, Department of Urology, Columbus, OH. Electronic address:

Objectives: To report and compare presentation and management of Fournier's Gangrene (FG) in female vs. male patients at a single tertiary care center.

Methods: Patient demographics, clinical characteristics, treatments and outcomes were summarized and compared between males and females who were treated for FG from 2011 to 2018 at a single institution. Read More

ANZ J Surg 2020 Jun 9. Epub 2020 Jun 9.

St. Vincent's Medical Center, Bridgeport, Connecticut, USA.

An Bras Dermatol 2020 May 16. Epub 2020 May 16.

Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil. Electronic address:

The severe bacterial diseases discussed herein are those that present dermatological lesions as their initial manifestations, for which the dermatologist is often called upon to give an opinion or is even the first to examine the patient. This review focuses on those that evolve with skin necrosis during their natural history, that is, necrotizing fasciitis, Fournier gangrene, and ecthyma gangrenosum. Notice that the more descriptive terminology was adopted; each disease was individualized, rather than being referred by the generic term "necrotizing soft tissue infections". Read More

Urol Case Rep 2020 Sep 10;32:101245. Epub 2020 May 10.

Head of Clinical Unit, Department of Urology, Port Elizabeth Provincial Hospital, South Africa.

Necrotising Fasciitis, also known as Fournier's Gangrene (FG), is a condition that rarely affects children. FG was first described by French venereologist, Jean Alfred Fournier in 1883. It is more common in adults and is strongly linked to immunosuppression. Read More

Cureus 2020 Apr 15;12(4):e7674. Epub 2020 Apr 15.

Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, USA.

The Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) Series and Approved Instructional Resources - Professional (AIR-Pro) Series were created in 2014 and 2015, respectively, in response to the growing need to curate online educational content as well as create a nationally available curriculum that meets individualized interactive instruction criteria for emergency medicine (EM) trainees. These two online series identify high-quality educational blog and podcast content using an expert-based approach. The AIR series is a continuously building curriculum originally based on the Council of Emergency Medicine Directors (CORD) testing schedule. Read More

Urol Case Rep 2020 Sep 3;32:101235. Epub 2020 May 3.

Brooke Army Medical Center, 3551 Roger Brooke Dr, Ft Sam Houston, TX, 78234, USA.

A 71 year old male presented to the emergency room for evaluation of acute erythema, edema and pain of the penis and scrotum. There was initial concern for Fournier's gangrene, however labs were unremarkable and vital signs were stable. He did not improve with antibiotics. Read More

In Vivo 2020 May-Jun;34(3):1499-1502

First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Background/aim: Fournier's gangrene is an uncommon, but extremely serious condition of necrotizing, soft tissue infection. There is a great debate regarding the management of larger defects and wound closure, with various techniques being described in the current literature. We aimed to present the surgical management of extensive Fournier's gangrene treated successfully with Vacuum-assisted closure (VAC) therapy, a novel approach to treatment algorithm that can lead to a paradigm shift. Read More

Abdom Radiol (NY) 2020 Apr 27. Epub 2020 Apr 27.

Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.

Fournier gangrene is an emergency condition that is associated with a high mortality rate. It is defined as a rapidly progressing infective necrotizing fasciitis of the perineal, perianal, and genital regions. Early diagnosis, broad-spectrum antibiotic coverage, and adequate surgical debridement are crucial and lead to better prognosis and patient survival. Read More

Mol Clin Oncol 2020 Jun 10;12(6):588-591. Epub 2020 Apr 10.

Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy.

Fournier's gangrene is a rare and severe complication reported in patients with cancer treated with antiangiogenic drugs, most frequently with bevacizumab. The present report describes the case of an 80-year-old man with radioactive iodine-refractory metastatic thyroid cancer treated with lenvatinib (an oral multikinase inhibitor with antiangiogenic properties) who developed Fournier's gangrene in the absence of other known risk factors. To the best of our knowledge, this is the first case described during treatment with lenvatinib. Read More

Intern Med 2020 Apr 16. Epub 2020 Apr 16.

Department of Endocrinology and Metabolism, Kashiwa Municipal Hospital, Japan.

Methicillin-resistant Staphylococcus aureus USA300, belonging to sequence type (ST) 8, is a rare cause of necrotizing fasciitis in the USA. We herein report a case of monomicrobial Fournier's gangrene caused by an ST8, methicillin-susceptible Staphylococcus aureus (designated ksw1). Whole-genome sequencing and analyses for virulence determinants revealed that, unlike USA300, ksw1 lacked virulence genes, such as Panton-Valentine leukocidin and SCCmec, while harboring the toxic shock syndrome toxin-1 gene. Read More

Wiad Lek 2020 ;73(2):293-297

Cracow University Of Economics, Cracow, Poland, Stefan Żeromski Hospital In Cracow, Poland.

Objective: The aim: To conduct an analysis of the complex treatment of severe forms of rectal abscesses complicated by NF.

Patients And Methods: Materials and methods: The results of treatment in 471 patients with deep forms of RA was performed. In 38(8%) the spread of the process and rotten-necrotic affection of the perineal fascia. Read More

Arch Argent Pediatr 2020 04;118(2):e204-e207

Servicio de Urología, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires, Argentina.

Fournier gangrene is a necrotizing fasciitis that affects the genital, perineal and perianal regions, of sudden onset and rapidly progressive dissemination. Its diagnosis requires an urgent and interdisciplinary intervention. The association with nephrologic diseases is rare. Read More

J Surg Case Rep 2020 Feb 24;2020(2):rjz414. Epub 2020 Feb 24.

Department of General Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead NSW 2145, Australia.

Rectal injuries secondary to fleet enemas are the result of a chemical irritation as well as mechanical trauma causing localized perforation and mucosal necrosis. These injuries can be managed expectantly. Fournier's Gangrene is a life-threatening, fulminant soft tissue infection of the genito-perineal region commonly secondary to a perianal infection, requiring extensive debridement of all affected tissue and judicious antibiotic therapy. Read More

Khirurgiia (Mosk) 2020 (2):68-73

Medical institute of the Penza State University, Penza, Russia.

National and foreign literature devoted to acute non-cryptogenic suppurations of pararectal tissue was analyzed. Own clinical observations are given. The unsolved questions of terminology and treatment strategy for this rare disease are discussed. Read More

Can Assoc Radiol J 2020 Feb 28;71(1):30-39. Epub 2020 Jan 28.

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.

Fournier gangrene (FG) is a genitourinary necrotizing fasciitis that can be lethal if not promptly diagnosed and surgically debrided. The diagnosis is often made by physical examination paired with an appropriate clinical suspicion and supporting laboratory values. Imaging, particularly computed tomography (CT), plays a role in delineating involved fascial planes for operative debridement and occasionally in diagnosing FG. Read More

J Immunother 2020 May;43(4):145-148

Department of Surgery and Transplantation.

Checkpoint inhibitor-induced side effects such as diarrhea and colitis occur in up to 30% of patients. We present a case of recurrent episodes of checkpoint inhibitor-induced colitis and subsequent Fournier gangrene that resolved after ileostomy formation. Once the Fournier gangrene and colitis had resolved, the ileostomy was reversed. Read More

Zhonghua Shao Shang Za Zhi 2020 Jan;36(1):70-76

Department of Burns, the First Baiqiu'en Hospital of Jilin University, Changchun 130021, China.

Fournier gangrene is a relatively rare clinical critical disease, and its clinical symptoms are not specific and easily unrecognized by some clinicians. It has the features of acute onset, quick development, severe illness, and often accompanied by infection shock which is seriously life-threatening. It is difficult in treatment with high medical costs and long length of hospitalization, which increases pain for patients and relatives and brings heavy economic and psychological burden on patients, society, and medical workers. Read More

FP Essent 2020 Feb;489:21-26

Maine-Dartmouth Family Medicine Residency, 15 East Chestnut St, Augusta, ME 04330.

Diabetes is associated with many complications, including foot ulcers. Individuals with diabetes have a 15% to 25% likelihood of developing a foot ulcer in their lifetime. The pathophysiologic mechanisms are multifactorial but the major etiologic factors are peripheral vascular disease and diabetic neuropathy. Read More

Chirurg 2020 Apr;91(4):307-312

Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Klinikum Hannoversch-Münden, Hannoversch-Münden, Deutschland.

Fournier's gangrene is a special form of necrotizing soft tissue infection (NSTI) and can affect the genital, perineal and perianal regions. Although the disease is named after Fournier, it was first documented by Baurienne in 1764. He described it as idiopathic rapidly progressive gangrene in young otherwise healthy men. Read More

Int J Infect Dis 2020 Mar 18;92:218-225. Epub 2020 Jan 18.

Department of Zoology, Science College, King Saud University, Riyadh 11451, Saudi Arabia; Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt. Electronic address:

Background: To provide better management of Fournier's gangrene, mortality-associated comorbidities and common etiologies were identified.

Methods: A systematic search was conducted using 12 databases, followed by meticulous screening to select relevant articles. Meta-analysis and meta-regression (for possible cofounders) were both done for all possible outcomes. Read More

Open Med (Wars) 2019 24;14:694-710. Epub 2019 Dec 24.

Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.

Fournier's gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes. In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia. Fournier's gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. Read More

Am J Med 2020 Jan 9. Epub 2020 Jan 9.

Department of Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan.

Chirurg 2020 Jan 9. Epub 2020 Jan 9.

Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.

Necrotizing fasciitis is a rare but always life-threatening disease, which necessitates a rapid diagnosis and immediate treatment. It can occur on the extremities as well as on the trunk and the perineum. It spreads rapidly along the fascia leading to septic shock. Read More

Int Marit Health 2019 ;70(4):216-219

Medical Centre, 3 A, SIDDHIVINAYAK CHAMBERS, 400051 MUMBAI, India.

A previously healthy Indian male seafarer aged 34 years, presented with vague perianal symptoms to the Master on a Very Large Crude Carrier (VLCC) in the Pacific Ocean. Over a few days, his condition deteriorated, and the company's medical consultant ashore, based on telephonic consultation, transmitted information and photos, diagnosed the condition as a life threatening case of Fournier's gangrene. The ship was then almost 1140 nm from the port. Read More

Zhonghua Shao Shang Za Zhi 2019 Dec;35(12):872-875

Department of Burns and Plastic Surgery, the People's Liberation Army Joint Service Support Unit 940 Hospital, Lanzhou 730050, China (Zhang Cheng is working at the Department of Burns and Plastic Surgery, Xi'an International Medical Center Hospital, Xi'an 710100, China).

To explore the effects of negative pressure wound therapy (NPWT) combined with delayed repair on Fournier gangrene in perineal region. During July 2010 to September 2018, 16 patients with Fournier gangrene in perineal region were admitted to our center, with 13 males and 3 females, aged 30 to 76 years. In the first stage, the necrotic tissue of the wound was completely removed according to the scope of the lesion, and NPWT was applied. Read More

BMJ Case Rep 2019 Dec 17;12(12). Epub 2019 Dec 17.

Clinical Physiology, King Saud University, Riyadh, Riyadh Province, Saudi Arabia.

A 51-year-old diabetic man diagnosed with prostatic abscess underwent its drainage twice. Following surgery he developed fever and right-sided painless visual loss due to endophthalmitis. To rule out its endogenous source CT scan was done which showed multisystem aetiology and complications. Read More

Abdom Radiol (NY) 2020 Jul;45(7):2063-2081

Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.

Imaging of the scrotum in the setting of acute symptoms such as pain or swelling is commonly performed emergently to differentiate between patients who require immediate surgery and those that do not. Acute scrotal symptoms are generally caused by infectious, traumatic or vascular etiologies. Rapid diagnosis and initiation of treatment is vital for testicular salvage in cases of acute testicular torsion, testicular rupture, and Fournier gangrene. Read More

Am J Cardiol 2019 12;124 Suppl 1:S45-S52

Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have a well-defined safety profile based on data obtained from numerous clinical trials, including cardiovascular outcomes trials (CVOTs) and postmarketing pharmacovigilance reporting. Adverse events including risk of genital mycotic infection and volume depletion-related events are consistent with the mechanism of action of this drug class. However, several emergent (albeit infrequent) serious safety issues have also been reported. Read More

Cureus 2019 Sep 26;11(9):e5778. Epub 2019 Sep 26.

Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, DEU.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a relatively new class of oral antidiabetic drugs. The US FDA has recently published a new warning about the safety of SGLT2 inhibitor administration in type 2 diabetes mellitus patients. There is an emerging evidence of an increased risk for developing Fournier´s gangrene (FG; a life-threatening complication) while under SGLT2 therapy. Read More

Mil Med 2020 Jun;185(5-6):e900-e903

Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708.

Testicular pain has a wide differential and the nonspecific presentation should be triaged rapidly for urgent diagnosis and treatment. Scrotal pyoceles are uncommon collections of purulent fluid between the visceral and parietal tunica vaginalis, usually secondary to acute epididymo-orchitis, intra-abdominal infection, or trauma. Epididymitis and epididymo-orchitis are generally secondary to sexually transmitted infections or urinary tract pathogens. Read More

J Emerg Med 2019 Dec 26;57(6):e167-e173. Epub 2019 Oct 26.

Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.

Background: Idarucizumab is a humanized, monoclonal antibody fragment used specifically to reverse the anticoagulant effects of dabigatran.

Case Reports: We discuss 4 cases of patients who were treated with idarucizumab to reverse dabigatran before early/emergency surgery. Two of the patients had subdural hematomas, 1 had a splenic laceration, and 1 had Fournier gangrene. Read More

Am J Med 2020 04 21;133(4):e143-e144. Epub 2019 Oct 21.

Medical student, Barts and The London School of Medicine and Dentistry, London, UK; King Edward Hospital, Paget, Bermuda.

Urol Case Rep 2020 Jan 12;28:101013. Epub 2019 Sep 12.

Baylor Scott and White Health, United States.

Chronic, massive lymphedema of the scrotum can pose therapeutic challenges to the urologist. Uncommonly encountered in developed countries, this dilemma can be amplified in the emergent setting. Along with voiding limitations and pain, lymphedema can lead to recurrent subcutaneous infections. Read More

BMJ Open Diabetes Res Care 2019 4;7(1):e000725. Epub 2019 Oct 4.

Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

Objective: Sodium glucose cotransporter-2 inhibitors (SGLT2i) exert cardiorenal protection in people with diabetes. By inducing glycosuria, SGLT2i predispose to genital infections. In addition, rare occurrence of Fournier's gangrene (FG) has been reported. Read More

Diabetes Obes Metab 2020 Feb 20;22(2):272-275. Epub 2019 Nov 20.

University of Florence, Clinical and Experimental Biomedical Sciences Department, Florence, Italy.

Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis of the perineum. The US Food and Drug Administration (FDA) released a Drug Safety Communication regarding the risk of FG associated with sodium-glucose co-transporter-2 inhibitors (SGLT2i), relying on the FDA Adverse Event Reporting System. To verify this association, we performed a meta-analysis of all randomized controlled trials enrolling patients with type 2 diabetes, comparing SGLT2i with placebo or different therapies, collecting cases of FG reported as a serious adverse event. Read More

Indian J Pediatr 2020 04 16;87(4):324-325. Epub 2019 Oct 16.

Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Plast Reconstr Surg 2020 01;145(1):231-234

Tampa, Fla. From the Department of Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida.

Perineal reconstruction historically has been guided by the vertical rectus abdominis myocutaneous flap. In oncologic patients, because of prior surgical intervention, this donor site is often unavailable, the pelvis has been irradiated, and defects can be deep or irregularly contoured. Using plastic surgery principles of perforators, geometrically defined local tissue rearrangement, and flap inset, the authors have developed a modification of the gracilis flap to include a second soft-tissue arm similar to a bilobed flap. Read More

Am Fam Physician 2019 10;100(7):435-436

Piedmont Columbus Regional Hospital, Columbus, GA, USA.

Emerg Med Clin North Am 2019 Nov 24;37(4):593-610. Epub 2019 Aug 24.

Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 6, Suite 1B-25, Bronx, NY 10461, USA. Electronic address:

Scrotal emergencies are rare but potentially life and fertility threatening. This article explains how to diagnose and manage scrotal emergencies such as testicular torsion, Fournier gangrene, and testicular trauma. These diagnoses are often difficult to discern from less-concerning causes. Read More

Urol Case Rep 2019 Nov 4;27:101001. Epub 2019 Sep 4.

St Vincent's Hospital, Sydney, Australia.

A case of Fournier's gangrene secondary to a self-administered penile augmentation is reported. A 45 year old man from the South pacific islands was successfully treated with surgical debridement, intensive care unit admission and antibiotics after presenting to hospital with Fournier's gangrene. Two years prior, he had self-administered Vaseline to the shaft of the penis in order to augment penile size. Read More

JAMA Intern Med 2019 Sep 3. Epub 2019 Sep 3.

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Ulus Travma Acil Cerrahi Derg 2019 Aug;25(5):479-483

Department of Infectious Disease and Clinical Microbiology, Abant İzzet Baysal University Faculty of Medicire, Bolu-Turkey.

Background: Fournier's gangrene (FG) is a very rare disease in daily urological practice. Despite medical improvements, mortality in FG is still high. Early diagnosis is very important to reduce additional instrumentations and mortality. Read More

J Emerg Med 2019 Oct 28;57(4):488-500. Epub 2019 Aug 28.

Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida.

Background: Fournier gangrene (FG) is a rare, life-threatening infection that can result in significant morbidity and mortality, with many patients requiring emergency department (ED) management for complications and stabilization.

Objective: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of FG.

Discussion: Although originally thought to be an idiopathic process, FG has been shown to have a strong association for male patients with advanced age and comorbidities affecting microvascular circulation and immune system function, most commonly those with diabetes or alcohol use disorder. Read More

Niger Med J 2019 Mar-Apr;60(2):95-97

Department of Urology, JIPMER, Puducherry, India.

Panurethral strictures are a surgical challenge for a reconstructive urologist more so in situations where local tissue for reconstruction is deficient. Two-stage urethroplasty is the preferred option in such cases. In some complex stricture diseases where patients are not willing for multiple procedures, permanent perineal urethrostomy can give a good functional outcome. Read More

J Surg Res 2020 01 23;245:516-522. Epub 2019 Aug 23.

Trauma Unit, Amsterdam UMC location AMC, Amsterdam, the Netherlands.

Background: A necrotizing soft-tissue infection (NSTI) is a rare but severe infection with a high mortality rate of 12%-20%. Diagnosing is challenging and often delayed. Treatment consists of surgical debridement of all necrotic tissue and administration of antibiotics. Read More

Int J Environ Res Public Health 2019 08 17;16(16). Epub 2019 Aug 17.

Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece.

Type 2 diabetes mellitus is a chronic metabolic disease associated with high cardiovascular (CV) risk. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are the latest class of antidiabetic medication that inhibit the absorption of glucose from the proximal tubule of the kidney and hence cause glycosuria. Four SGLT2i are currently commercially available in many countries: canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. Read More

Cureus 2019 Jul 19;11(7):e5173. Epub 2019 Jul 19.

Endocrinology, Diabetes and Metabolism, University of Arizona College of Medicine-Phoenix, Phoenix, USA.

Fournier's gangrene is an extremely rare infection that can occur in immunocompromised patients, especially those with diabetes. Given the severity of this infection and the new associated link to sodium-glucose cotransporter-2 inhibitors, the US FDA recently issued a warning in August 2018. Few cases of Fournier's gangrene have been reported in the literature in diabetic patients taking these oral medications. Read More