A 69-year-old Japanese man without significant comorbidities experienced anal pain 5 days before he was initially examined. Although he had been aware of a 5-mm perianal mass for a long time, he had ignored it because it had not caused any issues. Subsequently, he developed a fever of 38°C, his perianal pain worsened daily, and he was seen at our hospital’s emergency department. He did not have any urinary symptoms and denied recent sexual intercourse. There was no significant family history.
ASSESSMENT
Upon examination, the patient had a fever of 39.5°C, but his other vital signs were normal. A 5-mm perianal mass was found in the 12 o’clock position. Although he complained that the mass was painful, it showed few signs of inflammation, such as redness, heat, or swelling. There were no abnormal findings in the penile or scrotal skin. It was initially diagnosed as an infected epidermal cyst given that the mass had been previously noticed and based on the patient’s history of recent fever and pain. He was initially seen at the hospital on Saturday night and was asked to visit a surgical department the following Monday because the anal findings were mild and incision and drainage of the perianal area was too specialized a task to perform in the emergency department. The surgeon performed a simple computed tomography (CT) of the abdomen the following Monday that showed an abscess containing fluid and air in the subcutaneous tissues of the perianal region (Figure). A provisional diagnosis of Fournier gangrene was made. The patient was treated with immediate extensive surgical treatment on the day of the second visit. Necrotic changes in the fascia of genital area could be seen, thereby confirming the diagnosis of Fournier gangrene.
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-Teiko Kawahigashi, MD, Takashi Kawabe, MD, Hirokazu Iijima, MD, Mutsuo Takagi, MD, Yuma Suno, MD, Tomohiro Noda, MD, Kazunao Watanabe, MD
