-
International Journal of Surgery Case... Mar 2024Fournier's gangrene is a rare but life-threatening form of necrotizing soft tissue infection involving the perineal, genital, or perianal region, commonly caused by a...
INTRODUCTION
Fournier's gangrene is a rare but life-threatening form of necrotizing soft tissue infection involving the perineal, genital, or perianal region, commonly caused by a mix of aerobic and anaerobic organisms. Initially discovered in dental abscesses, Streptococcus anginosus have been increasingly reported in pyogenic and systemic infections with abscess formation. We present a rare case of perineal abscess that developed into Fournier's gangrene in which the causative pathogen isolated was S. anginosus.
PRESENTATION OF CASE
A 58-year-old male with uncontrolled type 2 diabetes, hypertension and hidradenitis suppurativa of the groin, presented with worsening testicular pain. He was found to have a necrotizing soft tissue infection of the perineum, consistent with Fournier's gangrene. He was successfully treated with multiple surgical debridement and broad-spectrum intravenous antibiotics. He was transitioned to oral antibiotics before transferring to a tertiary care facility for reconstruction.
DISCUSSION
The setting of uncontrolled diabetes and hidradenitis suppurativa may be the likely etiology for this peculiar case of Fournier's gangrene secondary to S. anginosus. Compromised tissue integrity and impaired local immune defenses from these etiologies predisposes to the development of Fournier's gangrene. Historically, these abscesses typically resolve after intravenous antibiotics and incision and drainage. However, the abscess in this case did not resolve but rather progressed to Fournier's gangrene. Perineal abscesses that grow S. anginosus should raise a high index of suspicion for worse outcomes.
CONCLUSION
In conclusion, we recommend a multidisciplinary approach and rapid diagnosis for the management of S. anginosus in the setting of a perineal abscess, with early aggressive surgical debridement and broad-spectrum antibiotics.
PubMed: 38310788
DOI: 10.1016/j.ijscr.2024.109319 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Septic pulmonary embolism (SPE) represents the occurrence of septic thrombi in circulation, originating from an extrapulmonary infectious source. Perianal and perirectal...
Septic pulmonary embolism (SPE) represents the occurrence of septic thrombi in circulation, originating from an extrapulmonary infectious source. Perianal and perirectal abscesses are frequently encountered anorectal issues, often stemming from obstructed anal crypt glands, resulting in pus accumulation within the subcutaneous tissue and intersphincteric plane. Timely surgical drainage is essential upon diagnosis of anorectal abscesses. Adult males exhibit a twofold higher incidence of anorectal abscesses and fistulae compared to females, with common symptoms including excruciating anal or rectal pain. This case report details the presentation and management of a 42-year-old male patient afflicted by perianal abscesses that led to SPE. The report underscores the importance of recognizing and treating anorectal abscesses promptly to avert potentially life-threatening complications such as sepsis and fistulae.
PubMed: 38882749
DOI: 10.4103/jpbs.jpbs_1091_23 -
Mikrobiyoloji Bulteni Jan 2024Actinotignum schaalii (formerly known as Actinobaculum schaalii) is an anaerobic or facultative anaerobic gram-positive bacillus that can be found commensally in the...
Actinotignum schaalii (formerly known as Actinobaculum schaalii) is an anaerobic or facultative anaerobic gram-positive bacillus that can be found commensally in the urogenital region. It can be overlooked because it grows slowly and is difficult to identify with classical microbiology laboratory techniques. Colonies become visible after 48-72 hours of incubation on blood agar in anaerobic or CO₂-rich media. While it typically causes urinary tract infection in older individuals, cases of bacteremia, vertebral osteomyelitis, endocarditis and cellulitis have been reported. Fournier's gangrene caused by A.schaalii has been reported very rarely so far. Fournier's gangrene has been defined as necrotizing fasciitis of the external genitalia, perineal and perianal region. Diabetes, immunosuppression, peripheral vascular disease, urethral anomalies, chronic alcoholism and smoking are important predisposing factors. In addition, approximately 25% of the cases have no known or identifiable etiology. The bacteria causing the infection may originate from skin, urogenital or intestinal microbiota. In this case report, a new case of Fournier's gangrene caused by A.schaalii was presented. A 65-year-old male patient admitted to the emergency department with the complaints of pain, swelling, redness in the left testis and also nausea, vomiting and chills that started three days ago. Physical examination revealed increased diameter of the scrotum, intense hyperemia of the skin and foci of necrosis. It was learned that the patient had no known chronic disease other than benign prostatic hyperplasia. The patient reported smoking of 25 packs of cigarettes per year. Routine laboratory tests revealed leukocyte= 32.41 x 109/L, neutrophil= 89.9%, procalcitonin= 1.62 ug/L, CRP= 265.07 mg/L and the patient was operated with the diagnosis of Fournier's gangrene. Gram staining of the abscess specimen obtained during the operation showed gram-positive bacilli both inside and outside the leukocytes. After 24 hours, grampositive bacilli were detected in the Gram staining of thin, transparent/gray colonies grown on 5% sheep blood and chocolate agar. The isolate was identified as A.schaalii by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) VITEK® MS (bioMérieux, France) microbial identification system. VITEK®2 ID ANC (bioMérieux, France) bacterial identification card was also used for comparison but the bacteria could be identified. As a result of the sequence analysis performed for confirmation, it was shown to be 100% homologous with Actinobaculum schaalii (GenBank accession no: FJ711193.1). For susceptibility tests, 5% sheep blood Schaedler agar was used and incubated in anaerobic environment. According to the minimal inhibitory concentration (MIC) results evaluated after 48 hours, penicillin was found to be 0.032 mg/L, clindamycin 0.125 mg/L, ciprofloxacin 0.19 mg/L, ceftazidime 4 mg/L, and amoxicillin 0.19 mg/L. The primary cause that initiated the infection in the case could not be identified, but it was thought that the presence of prostatic hyperplasia and smoking history may have contributed to the occurence or the progress of the disease. It is noteworthy that the ciprofloxacin MIC result was quite low compared to other studies. In addition, this study revealed the value of MALDI-TOF MS based methods in identification. In conclusion, it is thought that a significant proportion of A.schaalii infections may be overlooked due to the difficulty in growth and identification. Increasing the diagnostic power of clinical microbiology laboratories for poorly identified bacteria and renewing the databases of commercial identification systems are important for the early and accurate diagnosis and treatment of serious infections that may occur with such agents.
Topics: Male; Humans; Animals; Sheep; Aged; Fournier Gangrene; Agar; Actinomycetaceae; Bacteria, Anaerobic; Ciprofloxacin
PubMed: 38263943
DOI: 10.5578/mb.20249908 -
Cureus Sep 2023Hidradenitis suppurativa (HS), more commonly known as acne inversa, occurs due to chronic inflammation of the body's apocrine glands, most commonly affecting areas of...
Hidradenitis suppurativa (HS), more commonly known as acne inversa, occurs due to chronic inflammation of the body's apocrine glands, most commonly affecting areas of the body where there is prolonged skin-on-skin friction. HS affects approximately 4% of the United States population, most commonly women in their second or third decade of life, especially those of African American ethnicity. HS presents as tender subcutaneous nodules which often rupture, leading to the formation of painful dermal abscesses which undergo fibrosis and lead to the formation of extensive sinus tracts, a phenomenon known as "tunneling". HS is staged clinically using the Hurley staging system, where the stage determines what treatment modalities are used. These modalities can include medical management such as antibiotics, or biologics such as tumor necrosis factor (TNF)-alpha inhibitors like adalimumab, as well as surgical options including incision with or without drainage. Due to the similar presentation of HS with other conditions, this disease is commonly misdiagnosed, often leading to delayed treatment initiation and worse outcomes for patients. Presented is a case report of a 30-year-old African American male with perianal HS and the potential long-term complications and challenges of management of this disease.
PubMed: 37872932
DOI: 10.7759/cureus.45788 -
Cureus Mar 2024Infantile inflammatory bowel disease (IBD) is a very rare subgroup of IBD that develops in children younger than two years with genetic susceptibility, especially in...
Infantile inflammatory bowel disease (IBD) is a very rare subgroup of IBD that develops in children younger than two years with genetic susceptibility, especially in those with monogenic defects. This type, when compared with IBD in older children, is more resistant to conventional medical treatment and presents with more complications that require more surgical interventions. Our patient is a male with first-degree consanguineous parents. He was 16 months old when he presented with multiple perianal fistulas, fissures, abscesses, diarrhea, fever, and failure to thrive. He underwent a protective double-barrel ileostomy and surgical repair of the perianal disease. Crohn's disease was confirmed after endoscopy and biopsy. A genetic workup was done and revealed receptor-interacting protein kinase 1 () mutations. Conventional pediatric IBD treatment was initiated after surgery, including tumor necrosis factor antagonist adalimumab 40 mg subcutaneously weekly for five months. Despite treatment, he presented with dysuria and a colovesical fistula. The patient underwent secondary surgical repair.
PubMed: 38586767
DOI: 10.7759/cureus.55708 -
Cureus Apr 2024Chronic intestinal schistosomiasis (CIS) refers to the long-term effects of infection with Schistosoma parasites in the intestines. This condition typically develops...
Chronic intestinal schistosomiasis (CIS) refers to the long-term effects of infection with Schistosoma parasites in the intestines. This condition typically develops after repeated or prolonged exposure to contaminated freshwater containing Schistosoma eggs. The current study reports a case of an adult male, who complained of abnormal abdominal and anal pain for a month and had a medical history of complex perianal fistulae. The endoscopic investigation revealed different degrees of hyperemia, concentrated in the sigmoid colon and rectum. Lesions were localized in the rectum and sigmoid colon. Yellow granular hyperplasia, whether concentrated or dispersed, single or multiple polyps, along with observations of mucosal congestion, edema, faint vascular striations, erosions, superficial ulcers, and scattered petechial hemorrhages were noted. Also, the segmented areas of the colon had different degrees of inflammation. The microscopic histopathological analysis showed a culprit of surgical scar tissue. The granulomas harbored Schistosome parasites at the submucosal depth. Also, an erosion in the colonic mucosal tissues accompanied by lymphoplasmacytic and micro-abscess infiltrates was seen. A Schistosoma bilharzial ova was observed in the granuloma at the submucosal level. Endoscopic and histopathological investigations are useful tools to differentiate between CIS and Crohn's disease. These tools can distinguish CIS from Crohn's disease. Early detection and treatment are essential to prevent the progression of the disease and minimize long-term complications.
PubMed: 38770490
DOI: 10.7759/cureus.58614 -
BMC Infectious Diseases Feb 2024The outbreak of mpox that occurred between 2022 and 2023 is primarily being transmitted through sexual contact. As of now, there is no consensus on the recommended...
BACKGROUND
The outbreak of mpox that occurred between 2022 and 2023 is primarily being transmitted through sexual contact. As of now, there is no consensus on the recommended duration of isolation to prevent sexual transmission of the virus. Moreover, this particular mpox outbreak has presented with distinct complications in comparison to previous occurrences. In this report, we present a case involving severe rectal bleeding from an ulcer in a mpox patient with a history of engaging in receptive sexual contact.
CASE PRESENTATION
A 30-year-old Korean man presented at the hospital with complaints of fever, multiple skin lesions, and anal pain. Monkeypox virus polymerase chain reaction (PCR) results were positive for skin lesions on the penis and wrist. The patient received a 12-day course of tecovirimat due to anal symptoms and perianal skin lesions. Following isolation for 12 days and after all skin scabs had naturally fallen off, with no new skin lesions emerging for a consecutive 48 hours-conforming to the criteria of the Korean Disease Control and Prevention Agency-the patient was discharged. However, 1 day after discharge, the patient returned to the hospital due to hematochezia. His hemoglobin level had significantly dropped from 14.0 g/dL to 8.2 g/dL. Sigmoidoscopy unveiled a sizable rectal ulceration with exposed blood vessels, prompting the application of hemostasis through metal clipping. Subsequent monkeypox virus real-time PCR conducted on rectal tissue and swabs yielded positive results (with cycle threshold values of 28.48 and 31.23, respectively). An abdominal CT scan exposed a perirectal abscess, for which ampicillin-sulbactam was administered.
CONCLUSION
This case underscores the importance of monitoring for bleeding complications and confirming the resolution of rectal lesions before discharging patients from isolation, particularly in cases where patients have a history of engaging in receptive sexual contact with men or are presenting with anal symptoms.
Topics: Male; Humans; Adult; Mpox (monkeypox); Virus Shedding; Gastrointestinal Hemorrhage; Skin; Benzamides
PubMed: 38342913
DOI: 10.1186/s12879-024-09098-2