Fournier's Syndrome in a Ketoacidotic Diabetic Patient After Intrascrotal Insulin Injections Because of Impotence

Abstract

Fournier's syndrome is a necrotizing fasciitis most commonly confined to the male genitalia with high morbidity and mortality rates. The salient features are (1) sudden explosive illness in the midst of apparent health; (2) rapid necrosis and sloughing of tissues of the scrotum and penis; (3) absence of an obvious cause; (4) a mixed bacteriologic picture; and (5) gangrene affecting the whole thickness of the scrotal skin, but not the underlying testes. With the propensity toward life-threatening infections in patients with diabetes, it is surprising that Fournier's syndrome is not more common in suboptimally treated diabetic patients. This report is to illustrate the recognition and treatment of Fournier's syndrome in a patient with diabetes. Also, it must be emphasized that the explosive course of the disease process begins with a benign-appearing, epididymitis-like picture. Prompt recognition followed by prompt surgical debridement and appropriate antibiotic therapy along with surgical wound closure is necessary to reduce morbidity and mortality. The present case is unusual for the following reasons: (1) necrosis of the testicles requiring orchiectomy; (2) extensive spread of gangrene beyond the genitalia; and (3) the route of infection, which appeared to be intrascrotal injections of insulin in a vain attempt to cure impotence.