前立腺マッサージが引き金となった(?)Fournier's gangreneの1例

Abstract

We have experienced a case of Fournier's gangrene which progressed rapidly after prostatic massage. The patient was a 70-year-old man who had poorly controlled diabetes mellitus, hemorrhoid, urethral stricture and benign prostatic hyperplasia. He visited an urologist complaining of pollakisuria and miction pain. Under the diagnosis of prostatitis, prostatic massage was performed. From that night, he developed a high grade fever. Simultaneously, redness, swelling and pain of the scrotum progressed rapidly, and 11 days later, he was admitted to our hospital. An X-ray examination revealed subcutaneous gas formation in the scrotum. Immediately, incision and drainage with extensive debridement of necrotic tissue were performed combined with chemotherapy using broad spectrum antibiotics and insulin therapy. About 3 months later, the gangrene and the wound were healed with granulation and scarring. Cultures of the pus and the necrotic tissue from the scrotum were positive for Bacteroides fragilis and several aerobes including Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus and Staphylococcus epidermidis. The case proved to be non-clostridial gas gangrene.