Successful Treatment of Fournier’s Gangrene in Child with Relapsed Acute Lymphoblastic Leukemia: Case Report and Review of the Literature

Abstract

Neutropenia associated with onco-hematological treatment may contribute to high-mortality infections, especially caused by multidrug-resistant pathogens. In a 4-year-old girl treated due to early isolated central nervous system (CNS) relapse of B-cell acute lymphoblastic leukemia, skin lesions with traits of Fournier’s gangrene caused by Klebsiella pneumoniae carbapenemase (KPC)-producing Pseudomonas aeruginosa (PsA). The patient was treated with broad-spectrum antibiotic therapy and the wound was debrided and treated with VAC (vacuum-assisted closure) successfully. Despite further intensive anticancer treatment complicated by reactivation of PsA infection, there was no other episode of invasive infection anymore and, nowadays, the patient has been in complete remission for 13 months. The aim of this report is to mention that Fournier’s gangrene is a rapid and potentially fatal infectious complication of chemotherapy in onco-hematological pediatric patients, especially if caused by MDR (multidrug-resistant) pathogens. Successful treatment of this necrotizing fasciitis saves a patient’s life and allows to continue an effective anticancer therapy.