A female case of fournier's gangrene associated with diabetes mellitus

A 59-year-old woman with uncontrolled diabetes mellitus had been habitually scratching the vulva because of itch since 2013. She had fever, pain, and swelling of her genital area in September 2015. Four days later, she visited a clinic nearby and was diagnosed as having cellulitis and candidiasis of the vulva. Oral antibiotics and topical antifungal cream were prescribed but did not improve the symptoms. Therefore, she visited our department five days after the onset of her symptoms. On arrival, she had pain and swelling of the genital area. Computed tomography showed the presence of free air in the soft tissue of the vulva. Diagnosis of Fournier's gangrene was made, and we performed an emergency surgical debridement with antibiotic treatment. Because of the fast progression of necrosis, additional surgical debridements on the 5th, 7th, and 21st days were performed. Also, coloplasty was performed during the 3rd surgery. On the 42nd and 50th days, a defect of the abdominal skin was reconstructed by split-thickness skin grafting. The postoperative course was uneventful, and she was discharged on the 93rd day after hospitalization. There have been 183 reported cases of Fournier's gangrene, but only 11 (6%) of those cases were women.