Fournier's gangrene in childhood: a report of 3 infant patients

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Abstract

Fournier's gangrene is uncommon in pediatric age group, and little is known about the disease in the newborn period and infancy.

Three patients, aged 10 days, 14, and 17 months, with Fournier's gangrene, were treated in our hospital. The predisposing factors were prematurity, a diaper rash, and varicella infection, respectively.

Especially, prematurity and diaper rash are rare predisposing factors in the pediatric population; therefore, high index of suspicion, prompt diagnosis, conservative surgery, and multidisciplinary approach are the mainstays of management in children with Fournier's gangrene.

Section snippets

1. Case 1

A premature infant, born in the week 27 of gestation with a birth weight of 980 g, was taken into the newborn intensive care unit because of fetal stress.

The 1-minute and 5-minute Apgar scores were 5 and 8, respectively. Gentamicin, ampicillin, and cefotaxime were administered after blood and urine cultures were taken. Early enteral feeding with breast milk was begun on postnatal day 2. There was no history of rectal body temperature measurement or suppository application.

Perianal hyperemia was

2. Case 2

A 14-month-old male patient was referred to our university clinic because of necrotizing fasciitis in his perianal region and preputial skin.

His history revealed a diarrhoeal episode that appeared 4 days after beginning to take oral antibiotics for an upper respiratory tract infection, diagnosed 10 days before his admission. The perianal region was hyperemic, warm, and tender.

Within 2 days of the onset of hyperemia, the color of the affected area became darker and the temperature rose to 40°C.

3. Case 3

A 17-month-old female patient was evaluated for hyperemia and tenderness that had developed in her right groin and perineum after a varicella infection. The patient was admitted to surgical ward with the diagnosis of soft tissue infection and was administered intravenous ampicillin and clindamycin. A rapid local tissue necrosis with high fever developed in the affected area. The patient had a white blood cell count of 28,800/μL and a hemoglobin concentration of 11 g/dL. Blood and urine cultures

4. Discussion

Necrotizing fasciitis of genitalia and perineum, also known as FG is a rare, but life-threatening process [1], [2], [3], [4], [5]. Nowadays, FG is defined as an infective necrotizing fasciitis, which affects perianal and genital regions, leading to severe skin necrosis and thrombosis of subcutaneous vasculature. Necrotizing fasciitis in children is a rare disease that produces extensive cellulitis with severe involvement of the subcutaneous tissue, fascia, and muscle or both, resulting in

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