Fournier’s Gangrene in a Heterosexual Man: A Complication of Neisseria meningitidis Urethritis

A 55-year-old heterosexual male presented to the emergency department with a symptomatology consistent with urethritis and Fournier’s gangrene. Urethral swab and operative tissue cultures were positive for coagulase-negative Staphylococcus and an intracellular Gram-negative diplococcus. The latter was initially thought to be Neisseria gonorrhea; however, DNA sequencing technique confirmed it to be Neisseria meningitidis. The patient required three separate surgical debridements to control widespread necrotizing infection. Following documentation of sterile wound healing with appropriate antibiotics, four reconstructive surgeries were necessary to manage the resultant wound defects. To our knowledge, Neisseria meningitidis as a causative organism in Fournier’s gangrene has not been reported in the literature. 1. Introduction Fournier’s gangrene (FG) is a urologic emergency characterized by rapidly progressive necrotizing fasciitis of the male genitalia skin arising from infections in the perineal skin, scrotum, urethra, or the rectum. Multiple predisposing factors have been identified including diabetes mellitus, local trauma, paraphimosis, and urinary extravasation from urethral strictures [1]. Urologists must maintain high index of suspicion when encountering cellulitis at the genital region. A prompt diagnosis is necessary as infection can advance rapidly and result in a high mortality rate, particularly in diabetics, alcoholics, and in those with colorectal source of infection [2]. Emergent surgical debridement is necessary to control the infectious process, which may inevitably result in tissue loss. Bacterial cultures from FG wounds usually reveal polymicrobial infection that grows both aerobic and anaerobic pathogens such as Streptococci, Staphylococci, coliforms, Klebsiella, clostridia, Corynebacteria, and bacteroides [2, 3]. While urethritis caused by Neisseria meningitidis is an established clinical entity with frequent occurrences in heterosexual men [4–9], to our knowledge its implication in FG has not been documented. In this study we present the first case of FG that was caused by Neisseria meningitidis urethritis in a heterosexual man following orogenital transmission. The clinical surgical management will be described. 2. The Case 2.1. Patient Presentation A 55-year-old Caucasian male presented to the emergency department at our institution with the complaint of a two-day history of genital and lower abdominal pain. This was accompanied by increasing genital and lower abdominal skin erythema, along with a foul smell urethral discharge.