A Rare Case of Necrotizing Soft Tissue Infection in the Labium Resulting From Candida glabrata

Necrotizing soft tissue infections (NSTIs) are severe infections affecting the skin, subcutaneous, and muscle tissue. Tissue destruction, systemic toxicity, and increased morbidity are usually observed. An aggressive form of NSTI is called Fournier's gangrene: it starts as a necrotizing fasciitis of the perineal and genital area and affects adjacent soft tissue. It exhibits an increased rate of morbidity, thus requiring a high index of clinical suspicion to secure early surgical debridement. A 58-year-old patient presented in the emergency department complaining of pain in the labia majora. Clinical examination revealed tenderness, erythema, edema, and the presence of a large condyloma on the left labium majus. The patient was admitted and was treated with an antibiotic, with no improvement. A crackling sensation of the affected labium was observed on subsequent examination. Imaging revealed signs of necrosis, and NSTI was confirmed. The patient underwent surgical debridement of the perineum along with removal of the condyloma. A vacuum-assisted closure device was used for secondary healing of the surgical wound. Culture of the excised tissue and purulent discharge resulted in the isolation of a rare causative agent of fungal Fournier's gangrene, Candida glabrata. Thus, the patient's antibiotic treatment was escalated, and antifungal treatment was initiated with anidulafungin. The patient was discharged on the 32nd postoperative day. Delay in diagnosis and initiation of surgical treatment for NSTIs is the most significant factor affecting morbidity, which ranges between 20% and 40%. Despite the nonspecific signs and symptoms that often lead to misdiagnosis, timely recognition and intervention are crucial and can lead to a favorable outcome, as in this case.