An otherwise healthy 29-year-old male presented to the emergency department (ED) after being evaluated at an outside urgent care clinic for two days of fever, vomiting, and diffuse myalgias. Upon further questioning, he also endorsed severe scrotal pain and swelling and frequent masturbation with soap as a lubricant. He reported that past episodes of masturbation often resulted in recurrent penile erythema and abrasions which had worsened over the previous three days since his last masturbation episode. He denied any recent travel, notable lapses in personal hygiene, or any other preceding genitourinary injury or symptoms.
The patient appeared alert but ill and in pain, with rigors and a rectal temperature of 104.3°F. His initial blood pressure was 87/50 mmHg, heart rate was 124 beats/min, and respiratory rate was 24 breaths/min with an oxygen saturation of 100% on room air. His physical exam was remarkable for significant erythema, edema, and calor of the penis and scrotum extending to the region of the pubis symphysis but sparing the glans (Figure 1). A large malodorous eschar was noted to the ventral surface of the penis. Aggressive intravenous (IV) fluid resuscitation with normal saline was begun and, with a provisional clinical diagnosis of Fournier’s gangrene, IV clindamycin, and ampicillin/sulbactam, was administered, and surgery was consulted. His initial ED labs were remarkable for a white blood cell count of 12,000/mm3 and a lactate of 2.2 mEq/L.
While the occurrence of Fournier’s gangrene in an otherwise healthy young adult is unanticipated in modern times, frequent masturbation as the underlying cause of this condition is even more unexpected.