Post-Hydrocelectomy Fournier’s Gangrene in a Patient with Chronic Myeloid Leukemia on Imatinib Chemotherapy: A Case Report

Introduction: Fournier’s gangrene is a rare form of rapidly progressing necrotizing fasciitis of the the external genitalia and perineal region affecting all ages and gender but mostly older male. Diabetes mellitus, cancer, chemotherapy, HIV infection, inguinal herniorrhaphy and rarely hydrocelectomy are risk factors associated with Fournier’s gangrene. Patient Concerns and Diagnosis: A 56-year-old man on Imatinib for Bcr-Abl positive Chronic Myeloid Leukemia for 15 months underwent uneventful hydrocelectomy 8 days prior to presenting with fever, chills, rigor, scrotal pain and foul-smelling wound discharge. Patient was alert and awake. He had slight tachycardia and tachypnea. The scrotum was enlarged, edematous and tender to touch. Necrotized scrotal tissue with foul smelling discharge was evident. The hydrocelectomy wound was completely dehisced. The white count was normal. Hemoglobin was 9.3gm/dl and platelet count were 69, 000/mm3. Cultures, imaging studies and markers of inflammation were not available. The diagnosis of Fournier’s gangrene was made clinically. Intervention and Outcome: Fluid resuscitation, broad spectrum antibiotics were given.Within 24 hours of presentation, necrotic tissue was vigorously debrided and irrigated.Wound was left open while preserving the testes. Patient recovered well and discharged tofollow up with wound closure and further medical care as outpatient. Conclusion: Fournier’s gangrene is a rare and fatal disease that needs emergent care. Clinicians should be aware that FG may be a rare complication of hydrocelectomy like in this case. In mild to moderate cases the outcome may be good, even in resource limited environment, as far as it is recognized early and treated promptly