Fournier’s gangrene: a rare manifestation of Chikungunya fever

Fournier’s gangrene was first described by the venereologist Jean Alfred Fournier in 1883 as fulminant necrosis of the scrotum and penis following urogenital infection. It is a necrotising fasciitis of external genitalia. Predominantly seen in elderly men, diabetics and immunodeficient patients, it is a polymicrobial infection caused mainly by Escherichia coli, Klebsiella, Staphylococcus aureus, Streptococcus species and anaerobes. Fournier’s gangrene spreads extensively to the surrounding tissue and frequently results in septic shock and multi-organ failure. Active treatment includes broad spectrum intravenous antibiotics and radical surgical debridement of necrotic tissue. Chikungunya fever is caused by Chikungunya virus (family togaviridae, genus alphavirus) which is transmitted by the bite of infected Aedes aegypti and Aedes albopicusmosquitoes. Constitutional symptoms are high grade fever, a petechial or maculopapular rash of the trunk and occasionally limbs, and marked polyarthritis/ arthralgia, and intense headache, insomnia and extreme prostration. This disease is usually self-limiting but is associated with significant morbidity related to persistent arthritis and long-term anti-inflammatory therapy. Treatment is supportive. Mucocutaneous manifestations include facial flush, fine discrete morbilliform exanthema, pigmentary changes, apthous ulcers, desquamation, scrotal dermatitis and purpura. Though scrotal dermatitis or scrotal ulcers are rare manifestations, necrotising fasciitis may present in the form of Fournier’s gangrene. We hereby present such a case.