Fournier's gangrene complicating thrombocytopenia treated with steroids.

A 66-year-old man developed sudden perineal discomfort and fever with painful anal, penile, and scrotal oedema during treatment with steroids for severe thrombocytopenia of unclear origin (whether auto immune thrombocytopenia or myelodysplastic syndrome). An anal fi stula was observed and CT scan showed emphysematous gangrene of the perineum and scrotum, with testicles suspended in this emphysematous space (fi gure A, B). Gas gangrene had also aff ected the soft tissues below the skin, causing stretching of abdominal wall up to the hypochondrium area (fi gure C, D), as also shown by three-dimensional CT scans (fi gure E, F). Subsequently, thrombocytopenia resolved com pletely and steroids were stopped. The patient was diagnosed with Fournier’s gangrene—a lifethreatening necrotising fasciitis caused by a perineal abscess with infection of the anal fi stula. The patient was successfully treated with fl uid replacement, broadspectrum antibiotics, and debridement of necrotic tissue, followed by reconstructive surgery. Lancet 2014; 383: 1580