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Fournier gangrene in pregnancy. BACKGROUND: Fournier gangrene is a rare and rapidly progressive necrosis of the perineal and genitourinary region. Although predominantly affecting men, we describe an unusual presentation in pregnancy. CASE: A 30-year old primigravid woman in the third trimester of pregnancy presented with a history of low back pain. Subsequently, a diagnosis of perianal sepsis and associated Fournier gangrene was established. The patient underwent an emergency cesarean delivery followed by radical surgical debridement and colostomy. CONCLUSION: Expedited delivery, timely diagnosis of gangrene, urgent, extensive debridement, and broad-spectrum antibiotic coverage contributed largely to effective management of this rare presentation in pregnancy.