Zgraj et al. Journal of Medical Case Reports 2011, 5:576 http://www.jmedicalcasereports.com/content/5/1/576 was no evidence of testicular torsion. The wound was thoroughly washed with antiseptic solution. The dartos muscle and skin were closed primarily by means of absorbable sutures. The pyrexia was noted to settle soon after surgery. Edema, erythema, and pain settled over the following 48 hours. Wound cultures revealed Enterococcus sp. (ampicillin- sensitive) and Staphylococcus aureus (methicillin-sensi- tive). The antibiotic regime mentioned above was contin- ued for a total of 14 days (five days intravenously and the remainder orally). The baby was discharged home on the fifth post-operative day with oral antibiotics. Histology confirmed the intra-operative diagnosis (Figure 1). The baby has remained well, and wound healing was normal at follow-up in an out-patient clinic at two weeks, two months, and six months. The results of a scrotal exami- nation each time were normal. Page 2 of 3 Discussion Fournier gangrene is more common in adults - peak inci- dence occurs between 20 and 50 years of age - and is extremely rare in children. Only around 80 cases of necrotizing fasciitis have been reported in the literature [2-4]. Fournier gangrene can affect any part of the body in children, but the trunk and perineum are commonly affected in newborns. Like adults, preterm and low-birth weight babies with impaired immune status and those with poor local hygiene appear to have increased risk of this rare disease. An initial injury to the skin was docu- mented in the majority of children but was not noted or reported in up to 40% of cases in some studies [10]. When the skin barrier is breached, the organisms appear to spread into the subcutaneous tissue and pro- duce fascial necrosis with an obliterative endarteritis leading to further necrosis of tissue. The disease process, Figure 1 Histological findings (optical microscopy eosin-hematoxilin) of a four-week-old boy with necrotizing fasciitis of the scrotal wall. Ulcerated granulation tissue is shown. The arrow points to absent epidermis, indicating ulceration. Sections of hyper- and parakeratotic scrotal skin gave way to extensive ulceration. The dermis was replaced by remarkably inflamed granulation tissue and essentially comprised only capillaries and pus in many areas. The connective tissue was focally preserved adjacent to these necrotic foci. There was extensive ulceration of the surface also. No granulomas were identified. The appearance was that of necrotizing acute inflammation of the scrotal skin (Fournier gangrene).