Diagnosis: Fournier Disease
• Necrotizing fasciitis of the genital area is commonly referred to as Fournier gangrene. The disease is a rapidly progressive soft tissue infection with necrosis of tissue. Many cases result in extensive surgical resections or death.
• Elderly patients and immunocompromised patients (most commonly diabetics) are at increased risk. Local trauma is the usual entry for causative bacteria.
• The process is frequently polymicrobial. Any bacteria of the gastrointestinal or genitourinary tract can be involved.
• The main histologic features of necrotizing fasciitis include (1) necrosis of superficial and deep soft tissue including fascia, (2) brisk neutrophilic inflammation, (3) thrombosis and fibrinoid necrosis of arterioles, and (4) abundant bacterial organisms.
• Studies implicate a group A streptococcal serotype, named M1T1, in the pathogenesis of necrotizing fasciitis. This group of bacteria acquired numerous mechanisms that confer resistance to action of neutrophils, such as upregulation of factors that facilitate neutrophil apoptosis (streptolysin O), interleukin-8 degradation, and enhanced protease activity.
