Fournier's gangrene as the initial presentation of HIV infection.

摘要

A 48-year-old man presented with severe pain in the scrotum and right gluteal area. Three days earlier he had noted a small perianal abscess. The patient was a bike rider, smoker, and hypertensive with no alcohol consumption or diabetes and could recall no local trauma. On admission he was febrile (38 deg C), tachycardic (115 bpm), and hypotensive (98/66 mmHg). Examination of the genitalia revealed swelling, redness, pain on palpating the right gluteal and perianal areas, crepitations (subcutaneous gas), a foul smell, and dark fluid droplets on the scrotal skin. Laboratory results showed a white blood cell count of 18,740 cells/ mL (88% neutrophils); his coagulation, liver and kidney functions were normal. Physical examination and chest X-rays were normal. He was immediately treated with intravenous penicillin, clindamycin, and ofloxacin.