Severe Fournier's Gangrene Complicated by Polymicrobial Bacteremia and Persistent Abdominal Wall Fluid Collections...

Fournier's gangrene is a rapidly progressive necrotizing soft tissue infection of the perineal and genital regions associated with significant morbidity and mortality. Patients with poorly controlled diabetes mellitus are at particularly high risk for severe disease and complications. We present the case of a 57-year-old Hispanic male with uncontrolled type 2 diabetes mellitus (hemoglobin A1c of 12.2%), hypertension, and alcohol use disorder who presented with a two-week history of worsening scrotal pain and swelling. Computed tomography demonstrated extensive subcutaneous emphysema involving the perineum, scrotum, penis, bilateral inguinal canals, and anterior abdominal wall. The patient underwent multiple operative debridements, end colostomy creation, and prolonged antimicrobial therapy for polymicrobial bacteremia and severe sepsis. His hospital course was further complicated by bilateral abdominal wall fluid and gas collections concerning for abscess formation, requiring image-guided drainage and subsequent readmission for persistent collections. After a cumulative hospital stay of approximately seven weeks, he was ultimately discharged in stable condition. This case highlights the aggressive nature of Fournier's gangrene and the importance of early surgical intervention, repeated source control, and close follow-up for persistent or delayed infectious complications.