{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T15:49:49Z","timestamp":1766159389888,"version":"3.41.2"},"reference-count":14,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>In the setting of Fournier's gangrene, atypical clinical manifestations and complications in an immunocompetent patient warrant consideration of perineal tuberculosis as a potential underlying cause.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p><jats:italic>Tuberculosis cutis orificialis<\/jats:italic> is a rare form of extrapulmonary tuberculosis that affects the perianal region. Fournier's gangrene is an aggressive necrotizing fasciitis that primarily involves the perianal area and external genitalia. A previously healthy 38\u2010year\u2010old man presented with a left perianal abscess. His condition deteriorated, leading to septic shock and multiorgan dysfunction syndrome. A CT scan displayed extensive necrotizing fasciitis. Treatment included broad\u2010spectrum antibiotics, numerous surgical perineal debridements, a transverse loop colostomy, and hyperbaric oxygen therapy. We believe the patient had pre\u2010existing asymptomatic, non\u2010diagnosed perianal tuberculosis, and a subsequent bacterial superinfection resulted in a perineal local abscess that progressed to severe Fournier's gangrene. The diagnosis of tuberculosis was confirmed through positive cultures and molecular identification in perineal biopsies. The patient experienced a complex clinical course with complications such as myocardial necrosis, acute respiratory distress syndrome, rhabdomyolysis with severe critical illness polyneuromyopathy and internal jugular thrombosis. Fournier's gangrene resulted in air dissection throughout the perineal fasciae, extending to the abdominal wall muscles resulting in an infected extraperitoneal spontaneous hematoma, probably caused by therapeutic anticoagulation. An extraperitoneal surgical drainage was performed. This case emphasizes the complexities in diagnosing and managing both perianal tuberculosis and Fournier's gangrene.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.8882","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T03:49:47Z","timestamp":1714708187000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Perianal tuberculosis presenting as a Fournier's gangrene"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6430-1078","authenticated-orcid":false,"given":"Raquel","family":"Lalanda","sequence":"first","affiliation":[{"name":"General Surgery Department\u2014Centro Hospitalar Universit\u00e1rio Lisboa Norte EPE Hospital de Santa Maria  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreia","family":"Bar\u00e3o","sequence":"additional","affiliation":[{"name":"General Surgery Department\u2014Centro Hospitalar 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