Infection is one of the common causes of death in patients with
systemic lupus erythematosus (SLE). It is associated with the use of
immunosuppressive agents,
renal failure, and increased disease activity.
Fournier's gangrene is a
necrotizing fasciitis occurring in the genital region. It is rare, but can be crucial if surgical drainage is delayed. We report a female case of
Fournier's gangrene occurring in a patient with
lupus nephritis and
chronic renal failure. The patient was a 21-year-old female with
chronic renal failure due to
lupus nephritis. She had suffered from watery
diarrhea one month before admission. It improved after increasing the dose of
prednisolone, but, she was complicated with Bartholin
abscess. The vaginal
pain rapidly spread to the left lower quadrant abdomen despite treatment with oral
cephalosporin. Focal incision was performed and black fluid emerged with a foul smell. Pelvic computed tomography (CT) revealed many bubbles in that region. She was found to have
septic shock on transfer to our hospital. Thereafter, emergency
debridement was performed, followed by
antibiotic therapy and
hyperbaric oxygen therapy. Organisms were found to be 5 anerobes, such as Bacteroides species, and 3 aerobics, such as Morganella morganii.
Fournier's gangrene was improved via these treatments, but she needed maintenance
hemodialysis.
Fournier's gangrene complication should be considered in SLE with urogenital
infection.