Background A 59-year-old man presented with a 4-day history of scrotal pain and swelling and the rapid development of moist, black, foul-smelling lesions on the scrotum and penis. As a liver-transplant recipient, he was immunosuppressed. He also had type 1 (insulin-dependent) diabetes and poor nutrition, which might have compromised immunity further.

Investigations Physical examination, blood and tissue cultures, full blood count, urea and electrolytes, liver function tests, coagulation profile, C-reactive protein, and examination under anesthesia.

Diagnosis Fournier's gangrene originating from an infected cutaneous lesion in an immunocompromised patient.

Management Resuscitation and triple broad-spectrum antibiotics, urgent surgical debridement, serial examinations under anesthesia with further debridements, and split-skin grafting. Phallic reconstruction is planned.