International Journal of Clinical Dermatology


Submit a Manuscript

Publishing with us to make your research visible to the widest possible audience.

Propose a Special Issue

Building a community of authors and readers to discuss the latest research and develop new ideas.

Fournier's Gangrene - A Case Report with a Review of the Literature

Fournier's gangrene is a rare form of necrotizing fasciitis, also known as "flesh-eating disease." It cause extensive necrosis of skin, fascia, and subcutaneous of the external genitalia, perineal and perianal areas. The etiology is usually polymicrobial. Initial dermatological symptoms may be missing or mimicking erysipelas, cellulite or abscess. The disease is life-threatening with fulminant onset and prominent intoxication symptoms. Early diagnosis, complex treatment and urgent surgical debridement are crucial in reducing lethal outcome. We describe a case of a 38-year-old man with fever, erythema, edema and severe pain in his testicles and perineum 4 days before hospitalization. He was with poor general condition. The patient had a history of recent Covid-19 infection that worsened his metabolic syndrome and chronic pulmonary obstructive disease. Blood tests showed leukocytosis and extremely elevated C-reactive protein, and microbiological plating - beta streptococci and Staphylococcus aureus. Broad-spectrum antibiotics, aggressive debridement, adequate resuscitation and local treatment of the wound provided fast recovery and favourable outcome. An overview of the epidemiology, risk factors, etiological microorganisms, clinical picture, systemic and local complications, psychological problems, laboratory and imaging diagnostic methods of Fournier's gangrene is presented. Fournier’s gangrene and necrotizing fasciitis clinical risk assessment systems are also highlighted. Most appropriate therapeutic modalities are comprehensively discussed.

Fournier’s Gangrene, Life-Threatening Condition, Fasciotomy

APA Style

Hristo Mangarov, Valentina Broshtilova, Atanas Batashki, Svetlana Bezhanova, Yoanna Velevska, et al. (2023). Fournier's Gangrene - A Case Report with a Review of the Literature. International Journal of Clinical Dermatology, 6(2), 18-23.

ACS Style

Hristo Mangarov; Valentina Broshtilova; Atanas Batashki; Svetlana Bezhanova; Yoanna Velevska, et al. Fournier's Gangrene - A Case Report with a Review of the Literature. Int. J. Clin. Dermatol. 2023, 6(2), 18-23. doi: 10.11648/j.ijcd.20230602.12

AMA Style

Hristo Mangarov, Valentina Broshtilova, Atanas Batashki, Svetlana Bezhanova, Yoanna Velevska, et al. Fournier's Gangrene - A Case Report with a Review of the Literature. Int J Clin Dermatol. 2023;6(2):18-23. doi: 10.11648/j.ijcd.20230602.12

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Carroll PR, Cattolica EV, Turzan CW, et al. Necrotizing soft-tissue infections of the perineum and genitalia. Etiology and early reconstruction. West J Med. 1986; 144 (2): 174-178.
2. Stephens BJ, Lathrop JC, Rice WT, et al. Fournier’s gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance. Am Surg. 1993; 59: 149-154.
3. Short B. Fournier’s gangrene: an historical reappraisal. Intern Med J. 2018; 48 (9): 1157–1160.
4. Fournier JA. Gangrène foudroyante de la verge. La semaine médicale (Paris). 1883; 3: 345.
5. Wong CH, Chang HC, Pasupathy S, et al. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003; 85 (8): 1454-1460.
6. Mishra SP, Singh S, Gupta SK. Necrotizing Soft Tissue Infections: Surgeon Prospective. Int J Inflam. 2013; 2013: 609-628.
7. Wróblewska M, Kuzaka B, Borkowski T, et al P. Fournier’s gangrene - current concepts. Pol J Microbiol. 2014; 63 (3): 267-273.
8. Taken K, Oncu MR, Ergun M, et al. Fournier’s gangrene: Causes, presentation and survival of sixty-five patients. Pak J Med Sci. 2016; 32 (3): 746-750.
9. Wallace H, Perera T. Necrotizing Fasciitis. [Updated 2020 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available from:
10. Peetermans M, de Prost N, Eckmann C, et al. Necrotizing skin and soft-tissue infections in the intensive care unit. Clin Microbiol Infect. 2020; 26 (1): 8-17.
11. Thwaini A, Khan A, Malik A, et al. Fournier’s gangrene and its emergency management. Postgrad Med J. 2006; 82 (970): 516-519.
12. Singam P, Wei KT, Ruffey A, et al. Fournier’s Gangrene: A Case of Neglected Symptoms with Devastating Physical Loss. Malays J Med Sci. 2012; 19 (3): 81-84.
13. Goh T, Goh LG, Ang CH, et al. Early diagnosis of necrotizing fasciitis. Br J Surg. 2014; 101 (1): 119-125.
14. Singh A, Ahmed K, Aydin A, et al. Fournier's gangrene. A clinical review. Arch Ital Urol Androl. 2016; 88 (3): 157-164.
15. Voelzke BB, Hagedorn JC. Presentation and Diagnosis of Fournier’s Gangrene. Urology. 2018; 114: 8-13.
16. Kuzaka B, Wróblewska MM, Borkowski T, at al. Fournier’s Gangrene: Clinical Presentation of 13 Cases. Med Sci Monit. 2018; 24: 548-555.
17. Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, et al. Fournier's Gangrene: Literature Review and Clinical Cases. Urol Int. 2018; 101 (1): 91-97.
18. Gadler T, Huey S, Hunt K. Recognizing Fournier’s Gangrene in the Emergency Department. Adv Emerg Nurs J. 2019; 41 (1): 33-38.
19. Montrief T, Long B, Koyfman A, et al. Fournier’s Gangrene: A Review for Emergency Clinicians. J Emerg Med. 2019; 57 (4): 488-500.
20. Auerbach J, Bornstein K, Ramzy M, et al. Fournier’s Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives. Open Access Emerg Med. 2020; 12: 353-364.
21. Lewis GD, Majeed M, Olang CA, et al. Fournier's Gangrene Diagnosis and Treatment: A Systematic Review. Cureus. 2021; 13: 10-16.
22. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg. 2000; 87: 718-728.23. Tahmaz L, Erdemir F, Kibar Y, et al. Fournier’s gangrene: report of thirty-three cases and a review of the literature. Int J Urol. 2006; 13: 960-967.
23. Ozkan OF, Koksal N, Altinli E, et al. Fournier's gangrene current approaches. Int Wound J. 2016; 13: 713–716.
24. Herrero A. Therapeutic Manual Emergency Medicine and Procedures. 2016; 7th ed. McGraw-Hill. III.
25. Partin A, Dmochowski R, Kavoussi L, et al. Campbell-Walsh-Wein Urology. 2020; 12th ed. Elsevier. II. Gulias.
26. Vernon MP. Fournier’s Gangrene,, Updated: Jun 03, 2021.
27. Sorensen MD, Krieger JN. Fournier’s Gangrene: Epidemiology and Outcomes in the General US Population. Urol Int. 2016; 97 (3): 249-259.
28. Czymek R, Hildebrand P, Kleemann M, et al. New insights into the epidemiology and etiology of Fournier’s gangrene: a review of 33 patients. Infection. 2009; 37: 306-312.
29. McCormack M, Valiquette A, Ismail S. Fournier’s Gangrene: A Retrospective Analysis of 26 Cases in a Canadian Hospital and Literature Review. Can Urol Assoc J. 2015; 9: E407-410.
30. Sorensen MD, Krieger JN, Rivara FP, et al. Fournier’s Gangrene: population based epidemiology and outcomes. J Urol. 2009; 181 (5): 2120-2126.
31. Lynch CM, Pinelli DM, Cruse CW, et al. Maternal death from postpartum necrotizing fasciitis arising in an episiotomy: a case report. Infect Dis Obstet Gynecol. 1997; 5: 341-344.
32. Czymek R, Frank P, Limmer S, et al. Fournier’s gangrene: is the female gender a risk factor? Langenbecks Arch Surg. 2010; 395: 173-180.
33. Medhi R, Rai S, Das A, et al. Necrotizing fasciitis - a rare complication following common obstetric operative procedures: report of two cases. Int J Womens Health. 2015; 7: 357-360.
34. Ballard DH, Mazaheri P, Raptis CA, et al. Fournier’s Gangrene in Men and Women: Appearance on CT, Ultrasound, and MRI and What the Surgeon Wants to Know. Can Assoc Radiol J. 2020; 71 (1): 30-39.
35. Rouzrokh M, Tavassoli A, Mirshemirani A. Fournier’s gangrene in Children: Report on 7 cases and Review of Literature. Iran J Pediatr. 2014; 24 (5): 660-661.
36. Hagedorn J, Wessells H. A contemporary update on Fournier’s gangrene. Nature Reviews Urology. 2016; 14 (4): 205-214.
37. Sparenborg JD, Brems JA, Wood AM, et al. Fournier’s gangrene: a modern analysis of predictors of outcomes. Transl Androl Urol. 2019; 8 (4): 374-378.
38. Bloomgarden Z, Einhorn D, Grunberger G, et al. Fournier’s gangrene and sodium-glucose cotransporter 2 inhibitors: Is there a causal association? J Diabetes. 2019; 11 (5): 340-341.
39. Serrano Olave A, Bueno Moral AI, Martínez Bañón C, et al. Fournier’s Gangrene under Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Gynecological Patients. Int J Environ Res PublicHealth. 2022; 19 (10): 76-82.
40. El-Qushayri A, Khalaf K, Dahy A, et al. Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis. Int J Inf Dis. 2020; 92: 218-225.
41. Yılmazlar T, Işik Ö, Öztürk E, et al. Fournier’s gangrene: a review of 120 patients and mortality predictors. Ulus Travma Acil Cerrahi Derg. 2014; 20: 333-337.
42. Brennan M, LeFevre F. Necrotizing fasciitis: Infection identification and management. Nurs Crit Care.2019; 14 (1): 6-11.
43. Eğin S, Kamalı S, Gökçek B, et al. Four Determinative Factors in Fournier’s Gangrene Mortality. Turk J Colorectal Dis. 2019; 29 (1): 12-18.
44. Radcliffe RS, Khan MA. Mortality associated with Fournier’s gangrene remains unchanged over 25 years. BJU Int. 2020; 125 (4): 610–616.
45. Elmi AM, Kusbeci M, Osoble, et al. A case report of Fournier’s gangrene: Imaging ultrasound and computed tomography (CT) scan. Radiol Case Rep. 2022; 17 (3): 959-962.
46. Fernando SM, Tran A, Cheng W, et al. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis. Ann Surg. 2019; 269 (1): 58-65.
47. Creta M, Longo N, Arcaniolo D, et al. Hyperbaric oxygen therapy reduces mortality in patients with Fournier’s Gangrene. Results from a multi-institutional observational study. Minerva Urol Nefrol. 2020; 72 (2): 223-228.
48. Feres O, Feitosa MR, Ribeiro da Rocha JJ, et al. Hyperbaric oxygen therapy decreases mortality due to Fournier’s gangrene: a retrospective comparative study. Med Gas Res. 2021; 11 (1): 18-23.
49. Schneidewind L, Anheuser P, Schönburg S, et al. Hyperbaric Oxygenation in the Treatment of Fournier’s Gangrene: A Systematic Review. Urol Int. 2021; 105 (3-4): 247-256.
50. Hedetoft M, Bennett MH, Hyldegaard O. Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis. Diving Hyperb Med. 2021; 51 (1): 34-43.
51. Raizandha MA, Hidayatullah F, Kloping YP, et al. The role of hyperbaric oxygen therapy in Fournier’s Gangrene: A systematic review and meta-analysis of observational studies. Int Braz J Urol. 2022; 48 (5): 771-781.