Fournier's Gangrene Complicating Varicella in a B Cell Lymphoma Adult: A Case Report

Abstract

Introduction: Varicella (chickenpox) is generally a benign disease, but it can have serious consequences in immunocompromised individuals. Fournier’s gangrene as a consequence of varicella is rare. We report a rare case of Fournier’s gangrene complicating varicella in a young adult with B cell lymphoma. Case Presentation: We report a 22-year-old man with a history of type B cell lymphoma who had undergone two sessions of chemotherapy (R-CHOP protocol). He was admitted to the hospital for a feverish rash and perineal pain that had been developing for a week. Necrotic and oozing lesions were observed in the perineal region, penis, and thigh. A diagnosis of Fournier's gangrene complicating varicella was made. Despite initiation of intravenous acyclovir, ceftriaxone and metronidazole, surgical debridement was delayed until 10 days after symptom onset. The patient deteriorated, developed septic shock and died on the seventh hospital day. Discussion: The pathophysiology involves varicella-zoster virus–induced skin disruption allowing bacterial superinfection, often polymicrobial. Fournier’s gangrene remains a surgical emergency requiring early aggressive debridement to improve outcomes. Diagnostic and therapeutic delays common in resource-limited settings can be fatal. Conclusion: This case highlights the importance of early recognition and urgent surgical management of Fournier’s gangrene in immunocompromised patients with varicella. Preventive vaccination in at-risk populations may avert such outcomes.