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The introduction of new target therapies and immunotherapy combinations has dramatically improved the prognosis of cancer patients. Surgery and radiotherapy currently represent the cornerstones of loco-regional management, both for palliative and curative purposes. It is no coincidence, therefore, that in recent years the frequency of complications once considered rare has increased.

Here we present the case of a patient affected by metastatic bladder cancer whose treatments (surgery, radiotherapy, and targeted therapy) favored a rapid and acute onset of Fournier syndrome. The fulminant course prevented the establishment of a potentially effective treatment.

Fournier gangrene is an acute perineal necrosis caused by anaerobic bacteria. Management is complex and requires a quick multidisciplinary approach, even though, among cancer patients, mortality is very high.