**Abstract**

Fournier's gangrene is uncommon, a high-mortality infection that affects the subcutaneous tissue with rapidly progressive necrosis. Reports on cases involving the shoulder girdle are more rare. Similar to the presentation on other regions of the human body, fundamental is early diagnosis and surgical intervention.

**Keywords:** Fournier's gangrene, necrotizing fasciitis, shoulder girdle infection, acute necrotizing, shoulder

### **1. Introduction and epidemiology**

Fournier's gangrene is known by a variety of other names, necrotizing fasciitis (NF) such as hospital gangrene and hemolytic streptococcal gangrene, among others [1]. Necrotizing fasciitis (NF) is a rare and serious infection, characterized by extensive and rapidly progressive necrosis. Around 500–1500 cases/year are reported in the United States [2] but do not exist studies with profile in Brazil. It has an estimated greater involvement of males (3:1) at a mean age of 50 years. The predominant region of the body is in the perineal area. The mean mortality rate is high (32.2%), and if untreated, it can reach 100%.

Fournier's gangrene is a death-threatening infection caused by aerobic and/or anaerobic microorganisms. It affects the fascia and subcutaneous tissue with microcirculation thrombosis and rapidly progressive necrosis of the skin in the affected region (evolution reaches 2–3 cm/h) [3–6].

Reports on cases involving the shoulder girdle are uncommon. There are only eight cases of Fournier's gangrene (on the shoulder girdle) described in the literature, beginning after surgical procedures in the shoulder (arthroscopy or osteosynthesis) [7–9], or intra-articular infiltration in the shoulder (with corticosteroids) [10], or after closed trauma [11–13], or even without any trauma reported [14]. The description of two cases of necrotizing fasciitis after closed trauma, without the presence of injuries or immune depression conditions, intrigues and alerts us to the possibility of occurrence in any person. Fundamental is the early diagnosis and intervention in early surgery.
