key: cord-0972844-txu2pkz8 authors: Silva‐Alvarenga, Emanuela; Emile, Sameh Hany; Wexner, Steven D. title: Fournier's gangrene in a COVID‐19 patient with multiple comorbidities: Combatting the triple threat date: 2022-04-15 journal: Colorectal Dis DOI: 10.1111/codi.16139 sha: f308eb458b7760e51da2bcdc71ed3fa21a85b542 doc_id: 972844 cord_uid: txu2pkz8 When COVID-19 patients with multiple medical comorbidities present in an emergency setting with a highly morbid and possibly fatal infection associated with septicemia, this combination represents a triple threat that needs to be addressed in a meticulous and careful manner. The present report describes the management of a patient with COVID-19 and Fournier's gangrene, a triple threat that was managed at our hospital and despite the high odds of mortality due to his serious condition, the patient was able to survive. Despite the higher morbidity and mortality expected for COVID-19 comorbid patients undergoing emergency surgery, all efforts must be made to address the acute condition while taking the appropriate measures to prevent transmission of infection to the health care staff. The coronavirus disease 2019 (COVID-19) pandemic has made a striking impact on healthcare services [1] . During the first wave of the pandemic numerous elective surgeries were cancelled to provide more hospital beds and staff to treat an increasing number of patients infected with COVID-19 [2] . However, emergency procedures were exempt since they cannot be cancelled or postponed. The management of surgical patients undergoing emergency surgery requires special precautions to avoid morbidity and mortality [3, 4] . Additional precautions must be taken to protect healthcare personnel and surgical staff against contraction of COVID-19. When COVID-19 patients with multiple medical comorbidities present in an emergency setting with a highly morbid and possibly fatal infection associated with septicaemia, this combination represents a triple threat that needs to be addressed in a meticulous and careful manner. The present report describes the management of a high-risk patient with such a triple threat who was managed at our hospital and, despite the high odds of mortality due to his serious condition, the patient was able to survive. The patient is a 52-year-old man with a body mass index of 38.7 kg/m 2 , a smoker, has type II diabetes mellitus and essential hypertension complicated by end stage renal disease, and he has a history of stroke. The patient was not vaccinated against COVID-19. He presented to the emergency department with a 2-day history of tenderness at the left buttock area. Associated symptoms included high grade fever (38.3°C), malaise, cough and shortness of breath. On admission, the patient had tachycardia with a pulse of 116 bpm, elevated blood pressure and a normal temperature of 37.3°C. The oxygen saturation was 98% in room air. Complete blood count revealed a low haemoglobin level of 12.2 g/dl and highly elevated total leucocyte count of 31.9. Screening for COVID-19 was positive. The patient was admitted and underwent an urgent examination under anaesthesia. Digital rectal examination did not reveal any fluctuance or crepitus. There was no blood or pus inside the rectum. Second, there are measures that can be taken in COVID-19 patients that may prevent its progression to a more severe form. A 3-day course of remdesivir may lower the risk of hospitalization or death in early COVID-19 by 87% [7] . Also, monoclonal antibodies may prevent progression of mild to moderate COVID-19 to a severe disease. Early treatment for COVID-19 with SARS-CoV-2 neutralizing antibody sotrovimab was able to reduce the risk of progression of COVID-19 that led to hospitalization or death by 85% [8] . None of these measures, apart from regular monitoring of the oxygen saturation and blood gases of the patient, was used in this report, perhaps because these measures were not warranted based on the initial parameters of the patient, including a normal oxygen saturation that was continuously stable. Finally, the strict use of personal protective equipment, providing a separate pathway to manage COVID-19 surgical patients as formerly recommended [9] , and the use of evidence-based precautions all ensured the protection of the theatre staff and the team taking care of the patient. In conclusion, despite the higher morbidity and mortality expected for COVID-19 comorbid patients undergoing emergency surgery, all efforts must be made to address the acute condition while taking appropriate measures to prevent transmission of infection to the healthcare staff. None to be declared by the authors. Emanuela Silva-Alvarenga performed the procedure, collected the data and revised the manuscript. Sameh Emile wrote the manuscript. Steven Wexner critically revised the manuscript. A written informed consent for the publication of this record was obtained from the patient. 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