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.

Based on the clinical history and images, what is the likely diagnosis of the patient?

Test question

[Universidade Federal de Goiás – Residência Médica 2013 – Acesso Direto]

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:

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