What are the initial symptoms and progression of Fournier gangrene?

Updated: Jun 03, 2021
  • Author: Vernon M Pais, Jr, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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The hallmark of Fournier gangrene is intense pain and tenderness in the genitalia. The clinical course usually progresses through the following phases:

  1. Prodromal symptoms of fever and lethargy, which may be present for 2-7 days
  2. Intense genital pain and tenderness that is usually associated with edema of the overlying skin; pruritus may also be present
  3. Increasing genital pain and tenderness with progressive erythema of the overlying skin
  4. Dusky appearance of the overlying skin; subcutaneous crepitation
  5. Obvious gangrene of a portion of the genitalia; purulent drainage from wounds

Early in the course of the disease, pain may be out of proportion to physical findings. As gangrene develops, pain may actually subside as nerve tissue becomes necrotic.

Systemic effects of this process vary from local tenderness with no toxicity to florid septic shock. In general, the greater the degree of necrosis, the more profound the systemic effects.

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