Conclusions

Fournier gangrene may first be identified during the evaluation of syncope and sepsis even when no perineal or genital complaint is documented. In this case, syncope was not truly isolated because abdominal pain and systemic inflammatory findings were also present. Chronic AUD with associated hepatic and possible nutritional dysfunction was a plausible predisposing factor, although causation could not be established. In septic patients with unexplained abdominal or perirectal symptoms and relevant risk factors, clinicians should perform a targeted perineal examination and maintain a low threshold for CT and surgical consultation. Prompt antimicrobial therapy and surgical source control remain essential.