Fournier's gangrene in a woman with chronic neutropenia presenting at 12 weeks of pregnancy: a case report and literature review

The management of Fournier's gangrene in pregnancy in a woman with chronic idiopathic neutropenia is described. A 36-year-old pregnant woman was admitted at 12 weeks of gestation with sepsis, high fever, severe anemia requiring transfusions, and a perianal necrotic area approximately 10 cm in diameter extending to the perineum, consistent with Fournier's gangrene. She required both surgery and medical therapy. Surgery included a laparoscopic defunctioning sigmoid loop colostomy and perineal debridement. The skin and mucous membranes of the perineum were cleansed daily using water irrigation, decontamination and disinfection, and the vagina and rectum were irrigated with antiseptic and antifungal solutions. The necrotic areas were removed. Granulocyte colony-stimulating factor and erythropoietin were administered to restore normal levels of white blood cells and hemoglobin. Vital parameters, hematological values, and clinical examination of the perineum showed progressive improvement during treatment, and complete restoration of the perineum was achieved. The patient successfully carried the pregnancy to term. In conclusion, key factors for success were treatment of the sepsis, loop colostomy, granulocyte growth factor therapy and cleansing of the anus and perineum.