Division of Urology, Ivrea civil Hospital (ASL TO4), Ivrea (Turin).
Arch Ital Urol Androl. 2020 Oct 2;92(3). doi: 10.4081/aiua.2020.3.213.
Fournier disease (FD) is a worrisome infection of genital area caused by a polimicrobial infection and characterized by a rapid progression to necrosis. Scrotum, perineum and lower abdomen represent the primary sites of origin. Clinical presentation and laboratory strongly suggest FD, but if not precociously diagnosed, it may quickly evolve into septic syndrome and patient's death.
A 62 years old Caucasian male presented for fever and penile gross oedema recently occurred. No history of previous urinary tract infection, hematuria or genital trauma was referred. He did not complain any storage or voiding low urinary tract symptom (LUTS); no foci of infection in genitoperineal area was observed nor urethral discharge. The ultrasound (US) revealed a disomogeneous broad thickening of subcutaneous tissues with increased vascularity on Color-Doppler. When the penis was manipulated in order to reduce oedema, retract foreskin and evaluate the glans, clinical parametres rapidly worsened and the patient developed a septic shock with blood pressure falling down, dyspnoea and tachyarrhythmia, and he was fastly sent to Intensive Care Unit where it has been hemodynamically stabilized and subjected to antibiotic therapy. Considering the clinical absence of gangrene's foci, we opted for a conservative treatment by maintaining bladder catheter and drug therapy.
Fournier 病（FD）是一种令人担忧的生殖器区域感染，由多种微生物感染引起，其特征是迅速进展为坏死。阴囊、会阴和下腹部是原发部位。临床表现和实验室检查强烈提示 FD，但如果不能及早诊断，它可能迅速发展为败血症综合征并导致患者死亡。
一名 62 岁白人男性因近期发热和阴茎明显肿胀就诊。既往无尿路感染、血尿或生殖器外伤史。他没有任何储尿或排尿下尿路症状（LUTS）；生殖器区域也没有感染灶或尿道分泌物。超声（US）显示皮下组织不均匀性广泛增厚，彩色多普勒显示血管增多。当阴茎被牵拉以减轻肿胀、缩回包皮并评估龟头时，临床参数迅速恶化，患者发生感染性休克，血压下降、呼吸困难和心动过速，随后迅速转入重症监护病房，在那里患者的血流动力学得到稳定，并接受了抗生素治疗。鉴于临床上没有发现坏疽病灶，我们选择了保守治疗，保留膀胱导管并进行药物治疗。
