Campylobacter ureolyticus-associated Fournier's gangrene following anal fissure infection in a patient with diabetes and immunosuppression.
Shiori Kitaya, Miu Kitaoka, Hatsumi Otani et al.
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Case in brief
A 75-year-old man with type 2 diabetes receiving long-term corticosteroids presented with progressive scrotal pain and left thigh swelling. Examination showed scrotal necrosis, and contrast-enhanced CT revealed a perianal abscess with extensive subcutaneous emphysema. Emergency debridement and bilateral orchiectomy were performed. Pus cultures showed polymicrobial infection, while blood cultures also yielded Campylobacter ureolyticus, demonstrating discordance between specimen types. He recovered without major complications after broad-spectrum antimicrobial therapy and intensive glycemic control.
What made this case unusual
Blood cultures identified C. ureolyticus despite discordant findings in the polymicrobial pus cultures, illustrating how different specimens may reveal different organisms in spatially heterogeneous Fournier’s gangrene.
Diagnostic / clinical pearl
In severe polymicrobial Fournier’s gangrene, obtaining both local pus and blood cultures may help identify uncommon pathogens that are not detected in both specimen types.