Fournier's Gangrene in a Heterosexual Man: A Complication of Neisseria meningitidis Urethritis

Abstract

A 55-year-old heterosexual male presented to the emergency department with a symptomatology consistent with urethritis and Fournier's gangrene. Urethral swab and operative tissue cultures were positive for coagulase-negative Staphylococcus and an intracellular Gram-negative diplococcus. The latter was initially thought to be Neisseria gonorrhea; however, DNA sequencing technique confirmed it to be Neisseria meningitidis. The patient required three separate surgical debridements to control widespread necrotizing infection. Following documentation of sterile wound healing with appropriate antibiotics, four reconstructive surgeries were necessary to manage the resultant wound defects. To our knowledge, Neisseria meningitidis as a causative organism in Fournier's gangrene has not been reported in the literature.

Figure 1

Fournier's gangrene caused by Neisseria meningitidis: extensive perineal skin edema, erythema, and necrotic skin loss with exposed left testicle (black arrow).

Figure 2

Computed tomography of abdomen and pelvis showing (a) extensive edema and stranding of subcutaneous tissue at the symphysis pubis and bilateral groin areas; bilateral enlargement of inguinal lymph nodes is also noted (two arrows). (b) Edema and fat stranding extending into subcutaneous tissue at anterior lower abdominal wall area (two arrows).

Figure 3

Fournier's gangrene caused by Neisseria meningitidis: (a) the patient's wound after three surgical debridements; (b) the same wound following two weeks of daily dressing, vacuum-assisted wound closure, and antibiotic regimen.

Figure 4

Reconstruction of Fournier's gangrene wound: (a) bilateral medial thigh fasciocutaneous flaps for scrotal reconstruction were performed; (b) cadaveric skin graft of the penis and lower abdomen was necessary for temporary wound cover.

Figure 5

Full-thickness skin graft with 3 : 1 mesh was used to cover lower abdominal wound, while a thick-split-thickness skin graft was used to cover penile shaft skin loss. Allograft skin was obtained from the patient's thighs.

Figure 6

Healing of Fournier's gangrene wounds: skin graft and donor sites one week after surgery.