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Creta M, Sica A, Napolitano L, Celentano G, La Rocca R, Capece M, Calogero A, Califano G, Vanni L, Mangiapia F, Arcaniolo D, Spirito L, Fusco F, De Sio M, Imbimbo C, Mirone V, Sagnelli C, Longo N. Fournier's Gangrene in Patients with Oncohematological Diseases: A Systematic Review of Published Cases. Healthcare (Basel) 2021; 9:healthcare9091123. [PMID: 34574898 PMCID: PMC8469850 DOI: 10.3390/healthcare9091123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 12/29/2022] Open
Abstract
Patients suffering from hematological malignancies are at increased risk of Fournier's gangrene (FG) due to immunosuppression caused by the disease itself or by disease-related treatments. A systematic review of PubMed, ISI Web of Knowledge, and Scopus databases was performed in June 2021. We included full papers that met the following criteria: original research, human studies, and describing clinical presentation, treatment, and outcomes of FG in patients with oncohematological diseases. We identified 35 papers published from 1983 to 2021 involving 44 patients (34 males, 8 females) aged between 4 days and 83 years. The most common malignant hematological disorders were acute myeloid leukemia (n = 21) and acute lymphocytic leukemia (n = 9). In 10 patients FG represented the first presentation of hematological malignancy. Scrotum (n= 27) and perineum (n = 11) were the sites most commonly involved. Pseudomonas aeruginosa (n = 21) and Escherichia coli (n = 6) were the most commonly isolated microorganisms. Surgery was performed in 39 patients. Vacuum-assisted closure and hyperbaric oxygen therapy were adopted in 4 and in 3 patients, respectively. Recovery was achieved in 30 patients. FG-related mortality was observed in 11 patients. FG should be carefully considered in patients with oncohematological diseases.
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Affiliation(s)
- Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
- Correspondence: ; Tel./Fax: +39-081-7462-611
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80123 Naples, Italy;
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80130 Naples, Italy;
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Luigi Vanni
- Department of Public Health, University of Naples Federico II, 80130 Naples, Italy;
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Davide Arcaniolo
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (D.A.); (F.F.); (M.D.S.)
| | - Lorenzo Spirito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Ferdinando Fusco
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (D.A.); (F.F.); (M.D.S.)
| | - Marco De Sio
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (D.A.); (F.F.); (M.D.S.)
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy; (L.N.); (G.C.); (R.L.R.); (M.C.); (G.C.); (F.M.); (L.S.); (C.I.); (V.M.); (N.L.)
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D’Arena G, Pietrantuono G, Buccino E, Pacifico G, Musto P. Fournier's Gangrene Complicating Hematologic Malignancies: a Case Report and Review of Licterature. Mediterr J Hematol Infect Dis 2013; 5:e2013067. [PMID: 24363882 PMCID: PMC3867231 DOI: 10.4084/mjhid.2013.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 10/08/2013] [Indexed: 12/11/2022] Open
Abstract
Fournier's gangrene (FG) is a rare but severe necrotizing fasciitis of the external genitalia that may complicate the clinical course of hematologic malignancies and sometimes may be the first sign of the disease. The clinical course of FG is very aggressive and the mortality is still high despite the improvement in its management. Early recognition of FG and prompt appropriate treatment with surgical debridement and administration of antibiotics are the cornerstone of the management of this very severe disease. A review of the scientific literature focusing on the topic of FG complicating hematologic disorders is reported.
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Affiliation(s)
- Giovanni D’Arena
- Onco-Hematology and Stem Cell Transplantation Unit, IRCCS “Centro di Riferimento Oncologico della Basilicata”, Rionero in Vulture (Pz), Italy
| | - Giuseppe Pietrantuono
- Onco-Hematology and Stem Cell Transplantation Unit, IRCCS “Centro di Riferimento Oncologico della Basilicata”, Rionero in Vulture (Pz), Italy
| | - Emilio Buccino
- Surgical Department, “S. Giovanni di Dio” Hospital, Melfi (Pz), Italy
| | | | - Pellegrino Musto
- Scientific Direction, IRCCS “Centro di Riferimento Oncologico della Basilicata”, Rionero in Vulture (Pz), Italy
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Oiso N, Rai S, Kawara S, Tatsumi Y, Kawada A. Genital Infection as a First Sign of Acute Myeloid Leukemia. Case Rep Dermatol 2010; 2:18-21. [PMID: 21173921 PMCID: PMC3004206 DOI: 10.1159/000279328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Fournier's gangrene is a life-threatening disorder caused by aerobic and anaerobic bacterial infection. We report a case of genital infection as the initial warning sign of acute myeloid leukemia. We were able to prevent progression to Fournier's gangrene in our patient by immediate intensive therapy with incision, blood transfusions and intravenous administration of antibiotics. This case suggests that hematologists and dermatologists should keep in mind that genital infection can be a first sign of hematologic malignancy.
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Affiliation(s)
- Naoki Oiso
- Department of Dermatology, Kinki University School of Medicine, Osaka-Sayama, Japan
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Mantadakis E, Pontikoglou C, Papadaki HA, Aggelidakis G, Samonis G. Fatal Fournier's gangrene in a young adult with acute lymphoblastic leukemia. Pediatr Blood Cancer 2007; 49:862-4. [PMID: 16425246 DOI: 10.1002/pbc.20695] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the external genitalia. Few reports of FG exist in patients with hematologic malignancies. We describe a case of fatal FG in a 21-year-old man with acute lymphoblastic leukemia who was receiving remission-induction chemotherapy. Despite early local surgery, administration of appropriate antibiotics, resurgery for wider debridement and aggressive ICU support he succumbed while pancytopenic to septic shock, 26 days after initiation of chemotherapy. Multi-drug resistant Pseudomonas aeruginosa was isolated from blood and scrotal cultures obtained at initial surgery. FG is a fulminant infection, especially in the face of profound cytopenias.
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Affiliation(s)
- Elpis Mantadakis
- Department of Hematology, University Hospital of Heraklion, Heraklion, Crete, Greece
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Abstract
INTRODUCTION Infections following cord blood transplantation are just beginning to be defined in the literature. This review will outline infections at death, the epidemiology of individual infections, and the impact of stem cell source. METHODS A review of studies published since 2000. RESULTS Based on registry data, most studies demonstrate an approximate rate of infection at death of 30-40% among cord blood recipients. Bacterial infections often occur prior to engraftment and increase among patients with graft failure. In addition, there is delayed recovery of the immune response among patients with graft-versus-host disease that leads to viral infections at later time points. The risk of serious infection among children receiving umbilical cord blood (UCB) grafts is comparable to that of children receiving unmanipulated marrow and is lower than that of recipients of a T-cell-depleted stem cell source. Among adult patients, despite an overall higher incidence of serious infections after UCB transplantation as compared with unrelated donor grafts, non-relapse mortality and overall survival were not significantly different between haematopoietic stem cell sources. CONCLUSIONS Further studies are needed to confirm these observations and determine whether the risk of infection for cord blood recipients is comparable to that of recipients of unmanipulated marrow.
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Affiliation(s)
- J-A van Burik
- Division of Infectious Diseases, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
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Ferreira PC, Reis JC, Amarante JM, Silva ÁC, Pinho CJ, Oliveira IC, da Silva PN. Fournier's gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg 2007; 119:175-184. [PMID: 17255671 DOI: 10.1097/01.prs.0000244925.80290.57] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fournier's gangrene is a rare and potentially fatal infectious disease characterized by necrotic fasciitis of the perineum and abdominal wall, along with the scrotum and penis in men and the vulva in women. Fournier's gangrene is a true surgical emergency. Skin loss can be very incapacitating and difficult to repair. METHODS The authors reviewed retrospectively the clinical records of a series of 43 patients with Fournier's gangrene between the years 1985 and 2003 who, after initial treatment by the Departments of Urology and Surgery, were referred to the Department of Plastic Surgery for reconstruction. The following parameters were evaluated: age, gender, interval between onset of symptoms and diagnosis, clinical symptoms, lesion site, results of bacteriologic cultures, cause and predisposing factors, treatment and reconstructive procedures, length of hospital stay, and outcome. RESULTS The mean patient age was 56.6 years. Fifteen patients (34.9 percent) had diabetes mellitus. The cause of Fournier's gangrene was found in 32 patients (74.4 percent). The most common presentation was scrotal swelling, and scrotal involvement was found in 40 cases (93.0 percent). All of the patients underwent surgical debridement, and several reconstruction techniques were used. The mean length of hospital stay was 73.6 days. Two patients died. CONCLUSIONS Management of this infectious entity should be aggressive. Several techniques that are used to reconstruct the lost tissue have shown good results. The superomedial thigh skin flap has proven to be a reliable method of resurfacing large scrotal defects. Reconstructive surgery makes the return to a normal social life possible in many cases.
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Affiliation(s)
- Pedro Costa Ferreira
- Porto, Portugal From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital de São João, Porto Medical School
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Giagounidis AAN, Heinsch M, Kasperk R, Aul C. Fournier's gangrene. Ann Hematol 2003; 82:531-532. [PMID: 12811517 DOI: 10.1007/s00277-003-0688-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2003] [Accepted: 05/02/2003] [Indexed: 10/26/2022]
Affiliation(s)
- A A N Giagounidis
- Medizinische Klinik II, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, Germany.
| | - M Heinsch
- Medizinische Klinik II, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, Germany
| | - R Kasperk
- Klinik für Chirurgie, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, Germany
| | - C Aul
- Medizinische Klinik II, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, Germany
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