Fournier’s gangrene is a necrotizing fasciitis of the genital area that can extend to the perineum and the anorectal region [
4]. The majority of cases are polymicrobial and require emergent debridement and wide-spectrum antibiotic treatment [
4]. Colorectal sources (30–50%), urogenital sources (20–40%), cutaneous infections (20%), and local trauma are the main causative agents for Fournier’s gangrene [
5]. It is usually seen in immunocompromised patients such as those with diabetes or end-stage renal disease [
5]. Penile gangrene is a rare entity that can manifest in two forms: dry or wet, each of which requires different processing [
4]. Penile dry gangrene is the result of ischemia and is most commonly associated with long-standing diabetes mellitus and end-stage renal disease leading to secondary hyperparathyroidism [
4]. This situation will lead to calciphylaxis of the penile arteries and thus reduced blood flow [
4]. Less frequent causes include tourniquet effect, priapism, venous thrombosis, anticoagulant treatment, and injection of heroin in the femoral vessels, or penile prosthesis [
4]. Wet gangrene or “Fournier’s gangrene” is a synergistic necrotic fasciitis of genitalia, perineum, and abdominal wall. It is a rare, rapidly progressing, and potentially fatal soft tissue infection, first described by J.A. Fournier, who described 5 cases of penis and scrotum gangrene without obvious cause [
6]. Fournier’s gangrene is rarely truly idiopathic. However, recent studies indicate that FG seems to be more frequent in diabetes mellitus (most common), obesity, cancers, alcohol abuse, advanced age, poor hygiene, malnutrition, heart and peripheral arteries diseases, liver disease, chronic renal failure, HIV infection, and immunodeficiency. Furthermore, local trauma, periurethral urine leak, perineal surgery, paraphimosis, and penile sexual trauma have been implicated [
7]. Both aerobic and anaerobic microorganisms may be implicated in the infection, and cultures usually reveal
Escherichia coli [
7]. The time between diagnosis and treatment greatly affects morbidity and mortality, and it can quickly progress to sepsis [
4]. This is why it remains a life-threatening disease. The cornerstones of management are urgent patient resuscitation, broad-spectrum antibiotic therapy, surgical debridement, and reconstructive surgeries. Parenteral broad-spectrum antibiotics are required, including triple therapy: third-generation cephalosporins or aminoglycosides, plus penicillin and metronidazol, then adjusted according to the result of cultures. Early surgical debridement, under general or spinal anesthesia, is always recommended where necrotic tissue must be removed until the wound bed is clean [
4]. Almost all cases had good recovery after surgery and satisfactory reconstruction, using either skin graft or local scrotal flap [
7]. But in our case, the septic complication was fatal.