Atypical Presentation of Fournier Gangrene as Syncope in a Patient With Chronic Alcohol Use Disorder: A Case Report

Fournier gangrene is a rapidly progressive necrotizing soft tissue infection of the perineal and genital regions associated with substantial morbidity and mortality. Chronic alcohol use disorder (AUD) is a recognized predisposing condition because of its effects on immune function, nutritional status, and hepatic function. We report a 63-year-old man with AUD who presented after a syncopal episode with abdominal pain and systemic inflammatory response syndrome criteria but without a documented perineal or genital complaint. Computed tomography (CT) of the abdomen and pelvis demonstrated soft tissue gas surrounding the anorectal junction and extending into the perineum, concerning for Fournier gangrene. The patient underwent urgent incision and drainage of a perianal abscess, and wound cultures grew Klebsiella oxytoca and Raoultella ornithinolytica. Evaluation did not identify diabetes mellitus, human immunodeficiency virus infection, or the other evaluated predisposing conditions. No primary neurologic or cardiac cause of syncope was identified, and the systemic effects of sepsis were considered the most likely explanation. This case illustrates that Fournier gangrene may present with systemic symptoms in the absence of localizing perineal complaints. Prompt examination, imaging, surgical evaluation, and antimicrobial therapy remain essential.