Khattar Georges, Bou Sanayeh Elie, Makram Marina, Rabah Hussein, Abu Baker Saif, Khan Salman, Hong Catherine
Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, USA.
Touro College of Osteopathic Medicine, New York City, USA.
Eur J Case Rep Intern Med. 2024 Apr 23;11(6):004493. doi: 10.12890/2024_004493. eCollection 2024.
Fournier's gangrene represents a life-threatening necrotising infection affecting the perineal region, while hidradenitis suppurativa is characterised by a chronic inflammatory skin condition. The simultaneous occurrence of both conditions is exceedingly rare.
A 42-year-old female with a documented history of severe untreated hidradenitis suppurativa presented for shortness of breath, fever and lethargy, along with extensive wounds and skin breakdown involving the left axilla, perineum, lower back, lumbosacral region and bilateral gluteal areas, extending to the perineum. Upon presentation, the patient was in a state of septic shock, and a diagnosis of actively manifesting Fournier's gangrene was established at the site of the pre-existing hidradenitis suppurativa lesions. Despite the implementation of an aggressive multidisciplinary approach incorporating surgical interventions, antibiotic therapy and intensive care measures, the patient's condition deteriorated, culminating in septic shock, multi-organ failure and eventual demise. In this report, we discuss both clinical entities, their similarities and differences, and the possible mechanisms by which they may have co-occurred.
The co-existence of hidradenitis suppurativa and Fournier's gangrene poses unique challenges, given the rapid progression of Fournier's gangrene within the context of hidradenitis suppurativa, potentially suggesting the latter as a predisposing factor. This case underscores the importance of vigilant screening and management of hidradenitis suppurativa.
Clinicians should be aware of the potential association between hidradenitis suppurativa and Fournier's gangrene, especially in patients with shared risk factors.Both conditions present diagnostic and treatment challenges, emphasising the importance of a thorough differential diagnosis and a tailored selection of antibiotics.Proactive and continuous care is crucial in managing chronic diseases such as hidradenitis suppurativa to prevent severe complications, for example Fournier's gangrene.
福尼尔坏疽是一种危及生命的坏死性感染，累及会阴区域，而化脓性汗腺炎的特征是慢性炎症性皮肤病。这两种疾病同时发生极为罕见。
一名42岁女性，有严重未经治疗的化脓性汗腺炎病史，因呼吸急促、发热和嗜睡就诊，同时伴有广泛伤口和皮肤破损，累及左腋窝、会阴、下背部、腰骶部和双侧臀区，并延伸至会阴。就诊时，患者处于感染性休克状态，在先前存在的化脓性汗腺炎病变部位确诊为活动性福尼尔坏疽。尽管采取了积极的多学科方法，包括手术干预、抗生素治疗和重症监护措施，但患者病情仍恶化，最终导致感染性休克、多器官功能衰竭并死亡。在本报告中，我们讨论了这两种临床疾病、它们的异同以及它们可能同时发生的潜在机制。
鉴于福尼尔坏疽在化脓性汗腺炎背景下进展迅速，化脓性汗腺炎和福尼尔坏疽并存带来了独特的挑战，这可能表明后者是一个易感因素。本病例强调了对化脓性汗腺炎进行警惕筛查和管理的重要性。
临床医生应意识到化脓性汗腺炎与福尼尔坏疽之间的潜在关联，尤其是在有共同危险因素的患者中。这两种疾病都带来了诊断和治疗挑战，强调了进行全面鉴别诊断和针对性选择抗生素的重要性。对于化脓性汗腺炎等慢性病，积极持续的护理对于预防严重并发症（如福尼尔坏疽）至关重要。
