Fournier's Gangrene and Septic Cardiomyopathy in the Context of a Clinical Case: An Underestimated Diagnosis
DOI:
https://doi.org/10.37711/rpcs.2024.6.2.458Keywords:
cardiac arrhythmia, Fournier's gangrene, cardiomyopathy, sepsis, prolonged QT syndromeAbstract
Fournier's gangrene, frst described in 1883, is a necrotizing infection that occurs in the perineal and abdominal areas. It develops in patients with risk factors such as diabetes mellitus, obesity, alcoholism, hypertension, atherosclerosis, and immunosuppression. Its etiology is a polymicrobial synergy of gram-positive, gram-negative, and other pathogens, which require the presence of an initial lesion in the genital or perineal region and are responsible for tissue destruction, endarteritis, and microthrombosis. Systemically, they cause multiorgan failure, such as myocardial dysfunction induced by sepsis or septic cardiomyopathy, frst described in 1984, which can manifest as systolic or diastolic dysfunction of both ventricles, presence of
cardiac arrhythmias, preceded by QT interval prolongation, and elevated cardiac troponins.
This is similar to the presentation of our 71-year-old patient who had a favorable outcome.
Downloads
References
Lewis GD, Majeed M, Olang CA, Patel A, Gorantla VR, Davis N, et al. Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review. Cureus [Internet]. 2021 [Consultado el 30 de enero de 2024];13(10). Disponible en: https://www.cureus.com/articles/74306-fourniersgangrene-diagnosis-and-treatment-a-systematicreview
Flores-Galván KP, Quintero CAA, Guzmán-Valdivia GG. Gangrena de Fournier. Cir Gen. [Internet]. 2022 [Consultado el 25 de febrero de 2024]; 43(2):107- 14. Disponible en: https://www.scielo.org.mx/pdf/cg/v43n2/1405-0099-cg-43-02-107.pdf
Creta M, Sica A, Napolitano L, Celentano G, La Rocca R, Capece M, et al. Fournier’s Gangrene in Patients with Oncohematological Diseases: A Systematic Review of Published Cases. Healthcare [Internet]. 2021 [Consultado el 10 de enero de 2024];9(9):1123. Disponible en: https://doi.org/10.3390%2Fhealthcare9091123
Practical Review of the Current Management of Fournier’s Gan: Plastic and Reconstructive Surgery – Global Open [Internet]. 2021 [Consultado el 25 de febrero de 2024]. Disponible en: https://journals.lww.com/prsgo/fulltext/2022/03000/practical_review_of_the_current_management_of.22.aspx
Puia D, Gheorghinca S, Pricop C. The Antimicrobial Resistance Index and Fournier Gangrene Severity Index of Patients Diagnosed with Fournier’s Gangrene in a Tertiary Hospital in North Eastern Romania. Medicina [Internet] 2023 [Consultado el 26 de febrero de 2024];59(4):643. Disponible en: https://doi.org/10.3390/medicina59040643
Wetterauer C, Ebbing J, Halla A, Kuehl R, Erb S, Egli A, et al. A contemporary case series of Fournier’s gangrene at a Swiss tertiary care center—can scoring systems accurately predict mortality and morbidity? World Journal of Emergency Surgery [Internet]. 2018 [Consultado el 2 de marzo de 2024];13(1):25. Disponible en: https://doi.org/10.1186%2Fs13017-018-0187-0
Pol AG, Groeneveld AE, de Jong IJ, Mensink HJ. Fournier’s gangrene. Ned Tijdschr Geneeskd [Internet]. 1999 [Consultado el 2 de marzo de 2024];143(44):2177-81. Disponible en: https://pubmed.ncbi.nlm.nih.gov/10578408/
Narváez I, Canabal A, Martín C, Sánchez M, Moron A, Alcalá J, et al. Incidencia y evolución de la miocardiopatía
séptica en una cohorte de pacientes con sepsis y shock séptico. Medicina Intensiva [Internet]. 2018 [Consultado el 2 de marzo de 2024];42(5):283-91. Disponible en: https://medintensiva.org/es-incidencia-evolucion-miocardiopatia-septica-una-articulo-S0210569117302371
Benítez YQ, Aspuro GP, Cuza AA, Gómez LMQ, Fernández EH, Alpizar GL, et al. El corazón en la sepsis. Investigaciones Medicoquirúrgicas [Internet]. 2020 [Consultado el 2 de marzo de 2024];12(2). Disponible en: https://revcimeq.sld.cu/index.php/imq/article/view/636
Adrenergic Downregulation in Critical Care: Molecular Mechanisms and Therapeutic Evidence [Internet]. 2020
[Consultado el 2 de marzo de 2024]. Disponible en: http://ouci.dntb.gov.ua/en/works/73ZYPkQ9/
Aspuro GP, Benítez YQ. Evaluación ecocardiográfca de la miocardiopatía séptica. Importancia de los biomarcadores. Investigaciones Medico quirúrgicas. [Internet]. 2021 [Consultado el 5 de febrero de 2024];13(3). Disponible en: https://revcimeq.sld.cu/index.php/imq/article/view/735
De Geer L, Engvall J, Oscarsson A. Strain echocardiography in septic shock - a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome. Crit Care [Internet]. 2015 [Consultado el 5 de febrero de 2024];19(1):122. https://doi.org/10.1186/s13054-015-0857-1
Romero-Bermejo FJ, Ruiz-Bailen M, Gil-Cebrian J, Huertos-Ranchal MJ. Sepsis-induced cardiomyopathy. Curr Cardiol Rev. [Internet]. 2011 [Consultado el 5 de febrero de 2024];7(3):163-83. https://doi.org/10.2174/157340311798220494
Hollenberg SM, Singer M. Pathophysiology of sepsis-induced cardiomyopathy. Nat Rev Cardiol. [Internet]. 2021 [Consultado el 5 de febrero de 2024];18(6):424-34. https://doi.org/10.1038/s41569-020-00492-2 15. Lombardo Vaillant TA. Estudio clínico-epidemiológico sobre gangrena de Fournier en un hospital de Luanda. Enero de 2016 a diciembre de 2021. MediSur. [Internet]. 2022 [Consultado el 5 de febrero de 2024];20(3):515-26. Disponible en: https://n9.cl/zrl8
Yumura Y, Chiba K, Saito K, Hirokawa M. Fournier’s gangrene in a patient with malignant lymphoma: a case report. Hinyokika Kiyo. [Internet]. 2000 [Consultado el 7 de enero de 2024];46(10):735-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/11215202/
Lauerman MH, Kolesnik O, Sethuraman K, Rabinowitz R, Joshi M, Clark E, et al. Less is more? Antibiotic duration and outcomes in Fournier’s gangrene. J Trauma Acute Care Surg. [Internet]. 2017 [Consultado el 7 de enero de 2024];83(3):443-8. https://doi.org/10.1097/ta.0000000000001562
Wolach MD, MacDermott JP, Stone AR, deVere White RW. Treatment and complications of Fournier’s gangrene. Br J Urol. [Internet]. 1989 [Consultado el 9 de febrero de 2024];64(3):310-4. https://doi.org/10.1111/j.1464-410x.1989.tb06020.x
Schmidt C, Kurt B, Höcherl K, Bucher M. Inhibition of NF-kappaB activity prevents downregulation of alpha1-adrenergic receptors and circulatory failure during CLP-induced sepsis. Shock [Internet]. 2009 [Consultado el 11 de febrero de 2024];32(3):239-46. Disponible en: https://doi.org/10.1097/shk.0b013e3181994752
Cariou A, Pinsky MR, Monchi M, Laurent I, Vinsonneau C, Chiche JD, et al. Is myocardial adrenergic responsiveness depressed in human septic shock? Intensive Care Med. [Internet]. 2008 [Consultado el 11 de febrero de 2024];34(5):917-22. https://doi.org/10.1007/s00134-008-1022-y
Balija TM, Lowry SF. Lipopolysaccharide and sepsis-associated myocardial dysfunction. Curr Opin Infect Dis. [Internet] junio de 2011 [Consultado el 12 de enero de 2024];24(3):248-53. https://doi.org/10.1097/qco.0b013e32834536ce
Parrillo JE, Burch C, Shelhamer JH, Parker MM, Natanson C, Schuette W. A circulating myocardial depressant substance in humans with septic shock. Septic shock patients with a reduced ejection fraction have a circulating factor that depresses in vitro myocardial cell performance. J Clin Invest. [Internet]. 1985 [Consultado el 18 de enero de 2024];76(4):1539-53. https://doi.org/10.1172/jci112135
Fenton KE, Parker MM. Cardiac Function and Dysfunction in Sepsis. Clin Chest Med. [Internet]. 2016 [Consultado el 21 de enero de 2024];37(2):289-98. Disponible en: https://doi.org/10.1016/j.ccm.2016.01.014
Peetermans M, de Prost N, Eckmann C, Norrby-Teglund A, Skrede S, De Waele JJ. Necrotizing skin and soft-tissue infections in the intensive care unit. Clin Microbiol Infect. [Internet]. 2020 [Consultado el 25 de enero de 2024];26(1):8-17. doi: 10.1016/j.cmi.2019.06.031
Lima MR, Silva D. Septic cardiomyopathy: A narrative review. Rev Port Cardiol. [Internet]. 2023 May [Consultado el 25 de enero de 2024];42(5):471-481. doi: 10.1016/j.repc.2021.05.020
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Rommer Alex Ortega Martinez, Pachakutek Illescas Gonzales, Bismarck Raúl Ibañez Velasco
This work is licensed under a Creative Commons Attribution 4.0 International License.
