Fournier's Gangrene Associated with Local Cutaneous HPV Lesions in a Previously Healthy Girl

A case of an 11-year-old prepubertal girl with Fournier's gangrene is presented. The diagnosis was posed after the disease had progressed to the typical clinical picture of frank gangrene. A benign viral infection, common warts, possibly represents the initiating event of the development of this necrotizing soft tissue infection. The development of childhood Fournier's gangrene in association with viral infections has been reported in the past. An optimal outcome was achieved by aggressive antibiotic and surgical treatment despite the late diagnosis. In children, Fournier's gangrene develops in previously healthy individuals with benign diseases often representing the initiating events; thus, high index of suspicion is necessary for an early diagnosis that will lead to the optimal outcome. 1. Introduction Fournier’s gangrene (FG) is a potentially fatal necrotizing soft tissue infection of the perineal region. It is defined as a necrotizing fasciitis, of the perineal, perianal, and genital areas with extensive fascial necrosis, obliterative arteritis, and involvement of the adjacent skin. Necrosis of the superficial fascia is always more extensive than that indicated by the extension of skin necrosis. This polymicrobial synergistic infection spreads rapidly along the fascial planes and has a fulminant clinical course [1]. FG, initially described as a disease of young males, is now known to affect both sexes and all ages; the greatest incidence is observed among middle-aged immunocompromised men [2]. It represents a very rare clinical entity in childhood, and the majority of cases have been described in infants [3]. The prevalence of FG in the pediatric population remains unknown. Nevertheless, the incidence of necrotizing fasciitis of various anatomic localizations, including the perineal, has been reported to be 0.08/100.000 in children in comparison to 0.4/100.000 in adults [3]. In children, FG appears to have a more benign course and a better outcome compared to adults [4, 5]. Most pediatric cases of FG have been reported in previously healthy children, who may appear well in the early course of the disease and, thus, may escape diagnosis [1, 5]. Predisposing factors such as local trauma and infections, including viral infections, have been described in childhood FG [6]. Herein, we report a case of a previously healthy 11-year-old girl with FG. The disease was diagnosed after having had progressed to the typical clinical presentation. The detection of common dermal warts on the vulva and buttocks on clinical examination and the histological findings