Necrotizing fasciitis of the perineum associated with a bartholin abscess

Perineal gangrene was first described in healthy, young males more than two and one-half centuries ago. This disease, referred to commonly as Fournier gangrene, was marked by rapid progression, high mortality, and unknown etiology. In the last century the pathologic processes were described and accounts of perineal gangrene were reported in females. This disease still demonstrates a male predominance, but mortality does not demonstrate a gender predilection.

We present a case of a Bartholin abscess progressing to necrotizing fasciitis of the perineum in a 53-year-old female following drainage and marsupialization. Perineal gangrene was treated successfully with serial debridements and a targeted antimicrobial regimen, with wound closure by secondary intention.

Following retrospective case review, the exact pathophysiologic cause of progression to necrotizing fasciitis of the perineum is unclear though antibiotic resistance was a likely contributor.

Clinical studies are necessary to investigate the differential incidence of this disease, which may result from diagnostic unawareness of necrotizing fasciitis of the perineum in females due to adherence to Fournier's original description or coding bias. Future clinical studies may define risk factors for disease better, and allow for standardized management and improved outcomes regardless of gender.