Endocrine Abstracts

Introduction: Fournier’s gangrene (FG) is a rare but life-threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes, HIV, alcoholism and other immunocompromised states. We report the case of a patient who presented an inaugural diabetic ketoacidosis revealed by Fournier’s gangrene

Observation: A 38-year-old male patient with a smoking history, presented to the emergency department for intense perineal pain associated with a fever. The physical assessment had revealed a tachycardia of 120 bpm, blood pressure 110/60 mmHg, a high respiratory rate 24 per minute & a temperature of 39°C. The perineum was swollen and necrotic. An abdominal CT scan was performed which showed air bubbles at the perineal area extended to the retroperitoneal space and to the scrotal region. In the other hand the biological assessment was in favor of an elevated plasma glucose level of 4 g/l, metabolic acidosis and urine ketones.C-reactive protein level was at 235 mg/l with white blood cell count 18 per mm³. The diagnosis of a Fournier’s gangrene associated with an inaugural diabetic ketoacidosis was made. Management with intravenous fluids, insulin infusion and aerobic/anaerobic broad-spectrum antibiotics were started followed by surgical debridement without any complications. Discussion & conclusionFournier’s gangrene is a fulminant form of infective necrotizing fasciitis of the genital, perianal and perineal regions, which commonly affects men, but can also occur in women and children. Diagnosis should be prompt with early surgical intervention, along with antibiotics and good supportive care. Proactive management of diabetic and immunosuppressed patients with perineal infections is of extreme importance to prevent the development of the condition in the first place as this condition in the presence of such comorbidities is associated with high mortality