BACKGROUND: Fournier gangrene is a rare, life-threatening necrotizing fasciitis involving the perineum and external genitalia. It predominantly affects men, while cases in women are uncommon and often underrecognized, leading to delays in diagnosis and treatment. Although Fournier gangrene is frequently associated with immunocompromised states and diabetes mellitus, cases occurring in immunocompetent individuals remain exceptional.

CASE REPORT: We report a 40-year-old woman with obesity (BMI 39 kg/m²) and without immunodeficiency who presented with severe left labial pain and swelling 1 week after perineal shaving and topical herbal application. On examination, she had tachycardia, with marked tenderness and swelling extending to the suprapubic region. Laboratory investigations revealed significant inflammatory response. Computed tomography demonstrated extensive subcutaneous gas and fascial involvement of the vulva and perineum, consistent with necrotizing fasciitis. The patient underwent urgent surgical debridement followed by multiple re-explorations and negative-pressure wound therapy. Cultures identified extended-spectrum β-lactamase–producing Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae. Empirical broad-spectrum antibiotics were initiated, and subsequent culture-guided therapy allowed step-down from meropenem to amoxicillin-clavulanate. Definitive wound closure was achieved by secondary intention after prolonged inpatient care.

CONCLUSIONS: This case highlights that Fournier gangrene can occur following minor perineal manipulation in women without immunodeficiency. Obesity may mask early clinical signs and contribute to diagnostic delay. Early recognition, prompt imaging, aggressive surgical debridement, and multidisciplinary management remain essential for favorable outcomes, even in patients without classical risk factors. These findings reinforce the need to maintain a high index of suspicion in atypical presentations.

Keywords: Fasciitis, Necrotizing, Fournier Gangrene, Perineum, Vulvar Diseases