Sodium chloride
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Fournier’s gangrene caused by group-C streptococcus: case report A 21-year-old man developed Fournier’s gangrene caused by group-C streptococcus following abuse of sodium chloride. The man developed sharp, throbbing pain after an unprotected sex with a male partner. Over the last few hours, the pain worsened, and he presented to hospital. Upon presentation, he was afebrile, normotensive and tachycardic. Physical examination revealed enlarged scrotum with well demarcated erythema and central ecchymosis. A testicular ultrasound scan exhibited soft tissue oedema without vascular compromise or torsion. A bedside incision showed clean nonfriable tissue. Also, 250mL of serosanguinous fluid was drained. Laboratory tests revealed leucocytosis and lactic academia. The man was treated with fluid resuscitation. Broadspectrum antibiotics were started for suspected sepsis and scrotal cellulitis. Initially, his scrotal oedema, leucocytosis and lactic acidosis improved. However, he developed septic shock the following day. An emergency surgical management was required. During the operation, it was noted that his scrotum had necrotic tissue consistent with Fournier’s gangrene. He underwent debridement and near complete removal of the scrotum. On the subsequent day, growth of group-C streptococcus was noted in the cultures from the incision and drainage. Upon detailed investigation, he reported that he had self-administered 2Lof sodium chloride [normal saline] infusion into his scrotum before two days of the initial presentation for cosmetic effect. Subsequently, he was discharged on amoxicillin/clavulanic acid and clindamycin with a plan for eventual grafting. He was counselled regarding the risks of saline injection. Author comment: "This is the first case report to our knowledge describing Fournier’s gangrene as a consequence of scrotal inflation." "This atypical presentation was likely due to the preceding [sodium chloride] infusion." Fozouni L, et al. An oddball case of cellulitis, not just skin deep. Journal of Hospital Medicine 13 (Suppl.): no pagination abstr. 577, No. 4, Apr 2018. Available from: URL: https://www.shmabstracts.com/abstract/an-oddball-case-of803433885 cellulitis-not-just-skin-deep/ [abstract] - USA
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Reactions 16 Nov 2019 No. 1779
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