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Case Report
An atypical microbiology of Fournier gangrene related to Actinomyces spp.
1 School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
2 Division of Urology, University of Texas Medical Branch, Galveston, Texas, USA
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Frank Ventura
606 Ball Street, Galveston, Texas 77550,
USA
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Article ID: 100018Z15FV2021
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Ventura F, Harmouch W, Tahmassi N, Fernandez D, Srinivasan A, Sonstein J. An atypical microbiology of Fournier gangrene related to Actinomyces spp. J Case Rep Images Urol 2021;6:100018Z15FV2021.ABSTRACT
Introduction: Fournier’s gangrene (FG) is a rare necrotizing fasciitis affecting the perineum. Symptoms include tender, edematous scrotal tissue along with fever and can rapidly disseminate. Though FG is frequently a polymicrobial infection of Staphylococcus, Escherichia coli, and Pseudomonas, other pathogens may be involved. Here, we present a rare case of FG that isolated Actinomyces species from its soft tissue culture.
Case Report: A 61-year-old male with a history of uncontrolled type two diabetes mellitus and hypertension presented with a 1-week history of scrotal swelling and pain. He developed urge incontinence, fever, and nausea several days after symptom onset. Vitals demonstrated fever (100.8F) and the patient had bilateral scrotal swelling with erythema and warmth to palpation. Genitourinary (GU) exam was insignificant for crepitus, necrosis, or open wounds. Labs showed leukocytosis. Computed tomography (CT) confirmed the presence of soft tissue gas in the perineum and scrotum. The patient was started on empiric antibiotics and underwent emergency scrotal exploration and debridement. Tissue culture at the time presented with Actinomyces spp. with negative blood cultures. Antibiotics were deescalated to Unasyn. The patient underwent two additional debridements with repeat cultures negative for Actinomyces. A partial split thickness skin graft was performed to reconstruct the scrotum and antibiotics were discontinued.
Conclusion: The importance of early detection and intervention in patients with FG cannot be overstated. This case highlights a rare, likely underreported role of actinomyces in FG with absence of crepitus or necrosis on physical exam and emphasizes the importance of appropriately debriding and tailoring antibiotics to provide effective management.
Keywords: Case report, Fournier gangrene, Infectious disease, Urology
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Acknowledgments
We would like to acknowledge the Division of Urology at University of Texas Medical Branch for their support in accomplishing this case report.
Author ContributionsFrank Ventura - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Wissam Harmouch - Acquisition of data, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Nicholas Tahmassi - Acquisition of data, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
David Fernandez - Acquisition of data, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Aditya Srinivasan - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Joseph Sonstein - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Frank Ventura et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
