Early Clues in Diagnosing Fournier’s Gangrene

Necrotizing Fasciitis has a high mortality if not managed early, yet early diagnosis is inherently difficult. The external tissue is initially unaffected, therefore we rely on secondary signs of toxicity, which often represent an already established systemic infection. It typically effects immunocompromised patients, who are slow to manifest these secondary signs, complicating the diagnosis further. We present a case of an immunocompromised patient, who did not manifest typical signs of systemic infection. Atrial Fibrillation was the first clue to an underlying infection, and initially the only localising infective source was a hydrocele. Cutaneous features in keeping with a Fournier’s Gangrene occurred forty-eight hours later. This case highlights the difficulty in diagnosing Fournier’s Gangrene, and the possibility that a hydrocele in a septic patient may be reactive to a more sinister underlying necrotizing infection.