Fatih KARAÖZ
Middle Black Sea Journal of Health Science - 2026;12(2):294-302
Background: Fournier's gangrene (FG) is a rare but life-threatening necrotizing soft tissue infection of the perineal and genital regions. Although the disease classically presents with severe pain, erythema, edema, and systemic toxicity, atypical clinical manifestations may obscure early diagnosis and delay treatment. Review Text: This narrative review summarizes current evidence regarding atypical presentations of Fournier's gangrene, associated risk factors, diagnostic challenges, and management strategies based on recent literature. Atypical forms may present with minimal or absent cutaneous findings, lack of systemic symptoms, indolent progression, or unusual anatomical spread. These presentations are more frequently observed in patients with diabetes mellitus, malignancy, or immunosuppression. Diagnostic delays are common because atypical findings may mimic less severe soft tissue infections. Although imaging modalities -particularly computed tomography -are valuable for assessing disease extent, early diagnosis remains primarily clinical. Prompt recognition is critical, as delayed diagnosis is strongly associated with increased morbidity and mortality. Early aggressive surgical debridement, broad-spectrum antibiotic therapy, and supportive care remain the cornerstone of management. Conclusion: Atypical presentations of Fournier's gangrene represent a significant clinical challenge and are associated with worse outcomes due to delayed recognition. Maintaining a high index of suspicion in high-risk patients is essential for early diagnosis and timely intervention, which are key factors in reducing mortality.
