Taguchi Makoto, Inoue Takaaki, Nishida Teruhisa, Kawabata Takashi, Kawakita Shigenari, Muguruma Kouei, Murota Takashi, Kinoshita Hidefumi, Matsuda Tadashi
The Department of Urology, Kansai Medical University, Takii Hospital.
The Department of Urology, Kansai Medical University, Hirakata Hospital.
Hinyokika Kiyo. 2015 Nov;61(11):459-63.
Here, we report a case of pyoderma gangrenosum of the penis which was difficult to distinguish from Fournier gangrene. The patient was a 54-year-old male who was aware of redness and swelling of the glanspenis for 1 month prior to a consultation at our department. Although he was diagnosed with herpes and treated at a nearby hospital, his symptoms did not improve. Subsequently, the patient visited our department following the onset of pain and fever. During his initial consultation, he had a fever of 39 °C as well as redness and swelling of the glans penis with partial spontaneous purulent discharge. His blood test revealed an elevated white blood cell count (20, 000/μl) and C-reactive protein (19.1 mg/dl). Because Fournier gangrene was suspected, administration of broad-spectrum antimicrobial agents was initiated but proved to be ineffective. An abscess (2 cm in diameter) was also noted in the umbilical region.Enterococcus faecalis was detected by the bacterial culture ; and therefore, Fournier gangrene was diagnosed. A partial penectomy was performed to control the infection. Pathological findings showed only non-specific inflammation ; however, fever persisted postoperatively and blood test results showed no improvement. Furthermore, new abscess lesions emerged on the right heel and back. Because the re-performed abscess bacterial culture test result was negative, pyoderma gangrenosum was suspected, and he was started on oral prednisolone (20 mg/day). On the following day, his fever subsided and his blood test results also showed improvement. A final diagnosis of pyoderma gangrenosum was ultimately made.
在此，我们报告一例阴茎坏疽性脓皮病，其难以与福尼尔坏疽相鉴别。患者为一名54岁男性，在前来我院就诊前1个月就已意识到龟头红肿。尽管他被诊断为疱疹并在附近医院接受了治疗，但其症状并未改善。随后，患者在出现疼痛和发热后前来我院就诊。在初次就诊时，他体温达39℃，龟头红肿，有部分自发脓性分泌物。他的血液检查显示白细胞计数升高（20,000/μl），C反应蛋白升高（19.1mg/dl）。由于怀疑是福尼尔坏疽，开始使用广谱抗菌药物，但证明无效。在脐部还发现一个脓肿（直径2cm）。细菌培养检测到粪肠球菌；因此，诊断为福尼尔坏疽。进行了部分阴茎切除术以控制感染。病理结果仅显示非特异性炎症；然而，术后发热持续，血液检查结果未改善。此外，右足跟和背部出现了新的脓肿病变。由于再次进行的脓肿细菌培养检测结果为阴性，怀疑是坏疽性脓皮病，于是开始给他口服泼尼松龙（20mg/天）。第二天，他的发热消退，血液检查结果也有所改善。最终确诊为坏疽性脓皮病。
