Departmental Bulletin Paper Fournier壊疽との鑑別に難渋した陰茎壊疽性膿皮症の1例
A Case of Pyoderma Gangrenosum of the Penis Difficult to Distinguish from Fournier Gangrene

田口, 真  ,  井上, 貴昭  ,  西田, 晃久  ,  川端, 和史  ,  川喜多, 繁誠  ,  六車, 光英  ,  室田, 卓之  ,  木下, 秀文  ,  松田, 公志

61 ( 11 )  , pp.459 - 463 , 2015-11-30 , 泌尿器科紀要刊行会
Here, we report a case of pyoderma gangrenosum of the penis which was difficult to distinguish from Fournier gangrene. The patient was a 54-year-old male who was aware of redness and swelling of the glanspenis for 1month prior to a consultation at our department. Although he was diagnosed with herpes andtreated at a nearby hospital, his symptoms did not improve. Subsequently, the patient visited ourdepartment following the onset of pain and fever. During his initial consultation, he had a fever of 39°C as well as redness and swelling of the glans penis with partial spontaneous purulent discharge. His blood test revealed an elevated white blood cell count (20, 000/μl) and C-reactive protein (19.1 mg/dl). Because Fournier gangrene was suspected, administration of broad-spectrum antimicrobial agents was initiated butproved to be ineffective. An abscess (2 cm in diameter) was also noted in the umbilical region.Enterococcus faecalis was detected by the bacterial culture ; and therefore, Fournier gangrene was diagnosed. A partial penectomy was performed to control the infection. Pathological findings showed only non-specific inflammation ; however, fever persisted postoperatively and blood test results showed no improvement. Furthermore, new abscess lesions emerged on the right heel and back. Because the re-performed abscess bacterial culture test result was negative, pyoderma gangrenosum was suspected, and he was started on oral prednisolone (20 mg/day). On the following day, his fever subsided and his blood test results also showed improvement. A final diagnosis of pyoderma gangrenosum was ultimately made.

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