Fournier

Fournier's gangrene (FG) is an infectious disease characterized by necrotizing fasciitis of the perineal, perianal, or genital area associated with aging, ...

A thoracic-abdominopelvic computerized tomography (CT) (Figure [2](#figure-anchor-500659)) revealed a perineal and abdominal wall abscess with extension from the left hypochondrium to the upper part of the left thigh (17x4cm) with subcutaneous emphysema in the thoracic wall, confirming the suspected diagnosis of Fournier’s gangrene. Its clinical manifestations range from gradual onset and evolution to abrupt onset and fulminant evolution [[9]](#references). Diabetic patients are more susceptible to having a more severe FG, emphasizing the importance of proper metabolic control to avoid complications. This clinical case aims to increase awareness of the importance of a thorough physical examination and the need to consider less common diagnoses in order to treat these patients adequately to improve outcomes. In the immediate postoperative period, the patient evolved with hypotension and lactic acidosis and was then admitted to the intensive care unit (ICU) due to septic shock. Anaerococcus vaginalis is a gram-positive anaerobic coccus that causes ovarian, peritoneal, sacral, digital, and cervical abscesses [[13]](#references). [1](#figure-anchor-500656)) demonstrated subcutaneous emphysema in the left side of the thorax and abdomen. Laboratory data revealed a white cell count of 18,400/ul (normal range 4500/ul to 11,000/ul) with 17,400/ul neutrophils (normal range 2000/ul to 7500/ul) and a C-reactive protein of 27.9 mg/dl (normal range inferior to 0.5 mg/dl). The patient was immediately taken to the operating room for surgical drainage of the perineal abscess and debridement of necrotized tissue. The infection progresses as an obliterative endarteritis with micro thrombosis of cutaneous and subcutaneous arterioles resulting in the spreading of microbiological pathogens and gangrene of the surrounding tissue [[1]](#references). A 55-year-old male with a history of essential hypertension, dyslipidemia, smoking, and intermittent claudication presented to the emergency department with a four-day history of painful scrotal tenderness and fever. Diagnosis should be suspected in patients with erythema and swelling of the genitalia and perineal zone associated with disproportionate pain and subcutaneous emphysema [[5]](#references).