多発性骨髄腫の化学療法中に発症したフルニエ壊疽

FOURNIER'S GANGRENE AFTER CHEMOTHERAPY FOR MULTIPLE MYELOMA

　57歳の男性。化学療法施行後，末梢血白血球数が1000／mm³に低下したのに伴い高度の発熱と陰嚢の発赤・腫脹が出現した。フルニエ壊疽と診断し，抗生物質とG-CSFの投与を開始した。DICと敗血症を合併しており，膀胱瘻を造設し，皮下ドレーンを挿入したが，敗血症が悪化し救命し得なかった。

A 57-year-old man presented with fever and marked swelling of the scrotum. He had a long history of multiple myeloma requiring chemotherapy. The patient's tempera-ture was 39.4℃. He exhibited reddness, swelling, erosion and tenderness in the scrotum and inner aspect of the bilateral thighs. The white blood cell count was 1,000/ mm³. Piperacillin and amikacin with G-CSF were given. Immediate percutaneous cystotomy and subcutaneous drainage were done. Because he was in extremely poor surgical risk, radical debridement could not be performed and he died 20 days after the diagnosis of Fournier's gangrene.