(PNM-39) Isolated penile Fournier’s gangrene in two young adults: a case series

Abstract Introduction Fournier’s gangrene (FG) is a rapidly progressive and potentially fatal necrotizing fasciitis that typically involves the perineum and scrotum. Isolated penile involvement is exceptionally rare due to the region’s rich vascular supply and is sparsely described in the literature. This study aims to report two rare cases of isolated penile FG in previously healthy young males and to highlight substance abuse as a potential etiological factor. Materials and Methods We describe two clinical cases of isolated penile FG that presented within the same weekend. Both patients were previously healthy and reported recent substance use. Diagnosis was established based on clinical findings and confirmed by intraoperative tissue cultures. Management included broad-spectrum intravenous antibiotics, fluid resuscitation, surgical debridement, and postoperative vacuum-assisted closure (VAC) therapy. Results The first case, a 41-year-old male with recent cocaine use, developed rapidly progressive penile necrosis and underwent extensive surgical debridement followed by successful plastic reconstruction with a split-thickness skin graft. The second case, a 24-year-old male with regular use of synthetic cannabinoids (K2), also required urgent surgical intervention. In both cases, tissue cultures grew Streptococcus pyogenes as the sole pathogen. Both patients completed a 21-day course of antibiotics and demonstrated favorable clinical recovery. Conclusions Isolated penile FG is a rare but serious clinical entity that should be considered in young patients presenting with penile necrosis, even in the absence of traditional risk factors. Substance abuse may represent a potential trigger, and early diagnosis combined with aggressive surgical and supportive management is critical to achieving positive outcomes. Financing No conflict.