Sudden death due to atypical Fournier’s gangrene following Methicillin-resistant Staphylococcus aureus (MRSA) infection: a forensic case

Sudden death due to atypical Fournier’s gangrene following Methicillin-resistant Staphylococcus aureus (MRSA) infection: a forensic case

Stefano Tambuzzi^#, Guendalina Gentile^#, Enrico Muccino, Riccardo Zoja

Dipartimento di Scienze Biomediche per la Salute – Sezione di Medicina Legale e delle Assicurazioni – Università degli Studi di Milano, via Luigi Mangiagalli, 37, 20133 Milano, Italy.

^#co-first authors

Fournier’s gangrene is a rare and progressive necrotizing infection affecting the perineal, periureteral, perianal, or genital area associated with high mortality rates. A 34-year-old obese man went to the emergency room, complaining of painful perianal and perineal swelling. He was hospitalized and the computed tomography (CT) scan revealed large bilateral anorectal abscesses, anteriorly extended to the base of the scrotum and on the right to the ischiorectal fossa. A diagnosis of Fournier’s gangrene was made and broad-spectrum antibiotic therapy was started. After the abscesses drainage, microbiological examinations were performed. However, the clinical conditions furtherly worsened and the patient was moved to the medical intensive care unit. The microbiological analyses tested positive for Methicillin-resistant Staphylococcus aureus (MRSA) and the antibiotic therapy was modified accordingly. Despite the treatment, the hypotension worsened and the patient died from sepsis and multi-organ failure. Upon autopsy, we observed an external macroscopic picture devoid of the typical destructive lesions that usually characterize Fournier’s gangrene. Therefore, we found ourselves faced with an atypical case which, in the absence of the clinical data, would certainly have been difficult to diagnose based on the autopsy findings only.

The presented case is deemed of interest for both clinicians and medical examiners since it is about a highly aggressive and fatal Fournier’s gangrene in the absence of destructive external manifestations. Moreover, this atypical case of Fournier’s gangrene was sustained by an emerging and highly aggressive microbial agent, eventually evolved into sudden death.

Keywords: Autopsy; Fournier’s gangrene; S. aureus; Sudden death

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How to cite this article:

Stefano Tambuzzi, Guendalina Gentile, Enrico Muccino, Riccardo Zoja.Sudden death due to atypical Fournier’s gangrene following Methicillin-resistant Staphylococcus aureus (MRSA) infection: a forensic case. International Journal of Case Reports, 2022, 6:270. DOI: 10.28933/ijcr-2022-02-2805

References:

1. Bury D, Byard RW. Fournier gangrene and unexpected death. J Forensic Sci. 2012;57(6):1641-2. http://dx.doi.org/10.1111/j.1556-4029.2012.02139.x.
2. Taken K, Oncu MR, Ergun M, et al. Fournier’s gangrene: Causes, presentation and survival of sixty-five patients. Pak J Med Sci. 2016;32(3):746-50. http://dx.doi.org/10.12669/pjms.323.9798.
3. Benjelloun el B, Souiki T, Yakla N, et al. Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality. World J Emerg Surg. 2013;8(1):13. http://dx.doi.org/10.1186/1749-7922-8-13.
4. Bunai Y, Nagai A, Nakamura I, Ohya. Sudden unexpected death due to Fournier’s gangrene. Int J Legal Med. 1997;110(2):104-6. http://dx.doi.org/10.1007/s004140050042.
5. Capitan Manjon C, Sanchez AT, Charneco AS, et al. Fournier’s gangrene: a serious infectious disease. Eur Urol. 2003;Suppl. 2:18.
6. Burton MJ, Shah P, Swiatlo E. Community-acquired methicillin-resistant Staphylococcus aureus as a cause of Fournier’s gangrene. Am J Med Sci. 2008;335(4):327-8. http://dx.doi.org/10.1097/MAJ.0b013e318142b7b9.
7. Majdoub W, Mosbahi A, Bonbled F. Sudden unexpected death due to Fournier gangrene. Forensic Sci Med Pathol. 2019;15(1):155-8. http://dx.doi.org/10.1007/s12024-018-0030-7.
8. Vaidyanathan S, Soni BM, Hughes PL, et al. Localized necrosis of scrotum (Fournier’s gangrene) in a spinal cord injury patient—a case report. BMC Fam Pract 2002;3:20.