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A 47-year-old insulin-dependent type II diabetic man attends A+E with a 5-day history of right gradual-onset scrotal pain and swelling. He is apyrexial but tachycardic at 117 bpm and his blood pressure is 110/65 mmHg. On examination the right hemiscrotum is extremely swollen and approaching three times the size of the contralateral side. Most of the skin is indurated and erythematous, but there is an area 2 cm in diameter which is necrotic and on applying pressure, there is a ‘crackling’ sensation.
1. What is the likely diagnosis?
Fournier’s gangrene (necrotic fasciitis of the perineum).
2. What features in this history are concerning?
3. What key risk factor for this condition does this patient have?
4. The patient’s GP thinks that he has suffered a testicular torsion. Is the GP correct?
No. Untreated testicular torsion can result in Fournier’s gangrene, but the onset of pain would have been sudden.