PDF(Pubmed)
Abstract：
BACKGROUND: Fournier\'s gangrene usually occurs when a specific bacterium intrudes into soft tissue, causing a wound or tumor. We encountered a patient with Fournier\'s gangrene due to severe myelosuppression after chemotherapy, despite the absence of an initial lesion on the anus and rectum.
METHODS: A 54-year-old man with a left testicular cancer recurrence had undergone chemotherapy. He had asymptomatic hepatitis and high hepatitis B virus DNA levels, which were normalized by administering tenofovir alafenamide fumarate. Twelve days after the start of chemotherapy, he complained of severe pain around the anus. The following day, he went into septic shock. Visual inspection showed dark purple skin discoloration on the left side of the anus. Laboratory data revealed severe neutropenia. Computed tomography showed a high density of soft tissue on the left side of the anus and gas bubbles in the left femoral ring. We diagnosed the patient with Fournier\'s gangrene due to a severe immunosuppressive state resulting from chemotherapy. We emergently removed necrotic tissue to the fullest extent possible. However, because the patient was in severe sepsis status, careful management in the intensive care unit was required for 32 days. After the first emergency operation, we performed several additional excisions. Finally, 391 days after the initial surgery, the patient was discharged from our hospital. The tumor has not recurred, and he is under outpatient observation in the urology department.
CONCLUSIONS: Fournier\'s gangrene should be considered in patients who are in a severe myelosuppressive state due to chemotherapy, have normal hepatitis B virus DNA levels but high hepatitis B surface antigen after tenofovir administration, complain of severe pain in the perianal area, and have a dark purple skin discoloration around the anus, despite having no initial anorectal lesions.
METHODS: A 54-year-old man with a left testicular cancer recurrence had undergone chemotherapy. He had asymptomatic hepatitis and high hepatitis B virus DNA levels, which were normalized by administering tenofovir alafenamide fumarate. Twelve days after the start of chemotherapy, he complained of severe pain around the anus. The following day, he went into septic shock. Visual inspection showed dark purple skin discoloration on the left side of the anus. Laboratory data revealed severe neutropenia. Computed tomography showed a high density of soft tissue on the left side of the anus and gas bubbles in the left femoral ring. We diagnosed the patient with Fournier\'s gangrene due to a severe immunosuppressive state resulting from chemotherapy. We emergently removed necrotic tissue to the fullest extent possible. However, because the patient was in severe sepsis status, careful management in the intensive care unit was required for 32 days. After the first emergency operation, we performed several additional excisions. Finally, 391 days after the initial surgery, the patient was discharged from our hospital. The tumor has not recurred, and he is under outpatient observation in the urology department.
CONCLUSIONS: Fournier\'s gangrene should be considered in patients who are in a severe myelosuppressive state due to chemotherapy, have normal hepatitis B virus DNA levels but high hepatitis B surface antigen after tenofovir administration, complain of severe pain in the perianal area, and have a dark purple skin discoloration around the anus, despite having no initial anorectal lesions.
摘要：
背景：Fournier坏疽通常发生在特定细菌侵入软组织时，导致伤口或肿瘤。我们遇到了一个因化疗后严重骨髓抑制导致Fournier坏疽的病人,尽管肛门和直肠没有初始病变。
方法：一名患有左睾丸癌复发的54岁男性患者接受了化疗。他患有无症状肝炎和乙型肝炎病毒DNA水平高，通过服用富马酸替诺福韦艾拉酚胺使其正常化。化疗开始后12天,他抱怨肛门周围剧烈疼痛。第二天,他陷入了感染性休克.目视检查显示肛门左侧暗紫色皮肤变色。实验室数据显示严重的中性粒细胞减少。计算机断层扫描显示肛门左侧有高密度的软组织，左侧股骨环有气泡。由于化疗导致严重的免疫抑制状态，我们诊断患者患有Fournier坏疽。我们紧急地尽可能最大程度地去除坏死组织。然而,因为病人处于严重的败血症状态，重症监护病房的精心管理需要32天.第一次紧急手术后，我们进行了几次额外的切除。最后,初次手术后391天，病人出院了。肿瘤没有复发,他在泌尿科接受门诊观察。
结论：对于因化疗而处于严重骨髓抑制状态的患者，应考虑Fournier坏疽。有正常的乙肝病毒DNA水平，但高乙肝表面抗原替诺福韦给药后，抱怨肛周区域剧烈疼痛，肛门周围有深紫色的皮肤变色，尽管最初没有肛门直肠病变。
方法：一名患有左睾丸癌复发的54岁男性患者接受了化疗。他患有无症状肝炎和乙型肝炎病毒DNA水平高，通过服用富马酸替诺福韦艾拉酚胺使其正常化。化疗开始后12天,他抱怨肛门周围剧烈疼痛。第二天,他陷入了感染性休克.目视检查显示肛门左侧暗紫色皮肤变色。实验室数据显示严重的中性粒细胞减少。计算机断层扫描显示肛门左侧有高密度的软组织，左侧股骨环有气泡。由于化疗导致严重的免疫抑制状态，我们诊断患者患有Fournier坏疽。我们紧急地尽可能最大程度地去除坏死组织。然而,因为病人处于严重的败血症状态，重症监护病房的精心管理需要32天.第一次紧急手术后，我们进行了几次额外的切除。最后,初次手术后391天，病人出院了。肿瘤没有复发,他在泌尿科接受门诊观察。
结论：对于因化疗而处于严重骨髓抑制状态的患者，应考虑Fournier坏疽。有正常的乙肝病毒DNA水平，但高乙肝表面抗原替诺福韦给药后，抱怨肛周区域剧烈疼痛，肛门周围有深紫色的皮肤变色，尽管最初没有肛门直肠病变。
