Volume : 13, Issue : 09, September – 2026

Title:

FOURNIER’S GANGRENE COMPLICATED BY DIABETIC KETOACIDOSIS AND POLYMICROBIAL SEPSIS IN AN ELDERLY PATIENT WITH PERIPHERAL VASCULAR DISEASE: A MULTIDISCIPLINARY THERAPEUTIC APPROACH

Authors :

Roshinee R , Aman Christ P

Abstract :

Background: Fournier’s gangrene is a rapidly progressive necrotizing soft tissue infection of the perineal region associated with high morbidity and mortality, particularly in elderly patients with multiple comorbidities.
Case Presentation: A 69-year-old male with a known history of type 2 diabetes mellitus and peripheral vascular disease presented with an ulcer over the right scrotum, hematuria, and a chronic bed sore. On admission, the patient had uncontrolled hyperglycemia with a capillary blood glucose level of 300 mg/dL and was found to have metabolic acidosis with positive urine ketones, consistent with diabetic ketoacidosis. Clinical examination revealed necrotic lesions involving the scrotal region and pressure ulcers over bilateral trochanteric areas. Culture from the scrotal lesion isolated Escherichia coli sensitive to piperacillin-tazobactam, cefoperazone, and meropenem.
Intervention: The patient was managed with aggressive fluid resuscitation, insulin therapy for glycemic control, correction of electrolyte imbalance, and broad-spectrum intravenous antibiotics (piperacillin-tazobactam and metronidazole). Supportive measures including human albumin infusion, anticoagulation, and nutritional supplementation were also initiated as part of coordinated multidisciplinary management.
Outcome: Gradual clinical improvement was observed, with stabilization of blood glucose levels, resolution of ketoacidosis, and control of infection.[8]The patient was transitioned to oral medications on discharge, with advice for regular follow-up.
Conclusion: This case highlights the importance of early recognition, prompt broad-spectrum antimicrobial therapy, and multidisciplinary management in improving outcomes in Fournier’s gangrene complicated by diabetic ketoacidosis and multiple comorbid conditions.
Keywords: Fournier’s gangrene, Diabetic Ketoacidosis, Peripheral Vascular Disease, Polymicrobial Sepsis, Necrotizing Fasciitis, Broad-Spectrum Antibiotics, Multidisciplinary Management

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