Case 415 Medical history A 48-year-old man with uncontrolled type 2 diabetes presents with a 4-day history of progressive scrotal and penile pain, scrotal swelling and fever. Physical examination showed: regular general appearance, severe scrotum edema with local erythema and crepitus; positive cremasteric reflex. Digital rectal exam without masses or collections. Capillary blood glucose: 247 mg/dL, white blood cells: 12420 cells/mm³ (87% neutrophils, 3% band neutrophils) and C-Reactive Protein: 347 mg/L. Computed tomography of the pelvis was requested. Image 1: Axial computed tomography (CT) of the pelvis, section level of the inguinal region, without intravenous contrast.Image 2: Axial computed tomography (CT) of the pelvis, section level at the base of the penis, without intravenous contrast.Image 3: Axial computed tomography (CT) of the pelvis, section level of the scrotum, without intravenous contrast. Question:Based on the clinical history and images, what is the likely diagnosis of the patient? Testicular torsion Acute epididymo-orchitis Appendiceal torsion Fournier's gangrene Test question [Universidade Federal de Goiás – Residência Médica 2013 – Acesso Direto]Question:The presence of necrotizing soft-tissue infection in the genital region and perineum leads to the diagnosis of Fournier's gangrene. Among its clinical characteristics, the one that is NOT included is: Presence of lesions such as hyperemia, inflammation and necrosis of the penis and scrotum. High morbidity and mortality due to the aggressive infection. Broad-spectrum antibiotic therapy (gram-positive, gram-negative and anaerobic). Hyperbaric oxygen therapy as first-line treatment. Time is Up! Time's up
