A Case of Fournier's Gangrene under the Internal Use of Steroid with Lung Cancer

Takashi Yasuda¹⁾, Kentaro Kawasaki¹⁾²⁾, Takao Ichihara³⁾, Hiroki Morimoto¹⁾, Yukihiro Ando¹⁾, Shiro Takase¹⁾, Takashi Kamigaki¹⁾, Hajime Ikuta⁴⁾, Daisuke Kuroda¹⁾ and Yoshikazu Kuroda¹⁾

Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kobe University¹⁾
Department of Endoscopic Diagnostics and Therapeutics, Kobe University Hospital²⁾
Department of Surgery, Nishinomiya Municipal Central Hospital³⁾
Department of Surgery, Kasai City Hospital⁴⁾

A 59-year-old man, who had been taking oral gefitinib for five months for unresectable lung cancer after receiving chemotherapy for three years and also oral predonisolone for three months for interstitial pneumonitis caused by gefitinib, presented with a 2-week history of anal pain. After initial incision and drainage for a perianal abscess, the patient was hospitalized for persistent pain extending from the perianal region to the left buttock and the posterior side of the left thigh after two days. Pelvic computed tomography showed the swelling of subcutaneous soft tissue and presence of gas in the muscle layers. Extended incisions, lavage, debridement and Seton drainage were immediately performed under the tentative diagnosis of the Fournier's gangrene. Abscess fluid cultures yielded Staphylococcus epidermidis and E. coli. Split-thickness skin transplantation was performed on the open wound 35 days later. Since Fournier's gangrene is rarely caused by relatively minor wounds such as a perianal abscess in patients under steroid therapy, caution must be exercised when steroids are given to patients with underlying malignancy associated with depressed immunity.

Key words
Fournier's gangrene, steroid, Gefitinib

Reprint requests
Takashi Yasuda Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kobe University
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JAPAN

Accepted
January 31, 2007

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