Early Presentation of a Rare Complication of Sodium-Glucose Cotransporter-2 Inhibitors 10 Days After Initiation: Case Report and Literature Review&#x0D;

Elshimy, Ghada; Correa, Ricardo; Alsayed, Mahmoud; Jyothinagaram, Sathya

doi:10.7759/cureus.5173

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…We searched the medical literature in PubMed and Google Scholar between May 2013 and July 2019 with the keywords SGLT2 inhibitors and Fournier’s gangrene and retrieved five reports that were described in detail. Each report described a patient who developed FG after commencing treatment with dapagliflozin and empagliflozin (Table 2) [8–12]. Most of those cases involved patients who had T2DM that was reasonably or poorly managed [glycated hemoglobin (HbA lc ) > 7.0%], unlike our patient, who had good glycemic management (HbA lc < 7.0%) at the time of FG onset.…”

Section: Discussionmentioning

confidence: 99%

Fournier’s Gangrene in a Patient with Type 2 Diabetes Mellitus Treated with Empagliflozin: A Case Report

Nagano

Yakame

Aoki

et al. 2019

Drug Saf - Case Rep

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Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been reported as possibly associated with Fournier’s gangrene (FG). This case report describes a 34-year-old Japanese man who was diagnosed with FG after the administration of empagliflozin for type 2 diabetes mellitus (T2DM). He presented with pain and swelling in the perineum and groin 142 days after initiating empagliflozin. The clinical features, laboratory data, and computed tomographic findings were consistent with FG. Surgical drainage and debridement of necrotic tissues were performed immediately after admission to our hospital. The patient had no complications of diabetes before the onset of FG. Glycemic management was good at the time of FG onset. This case suggests a possible association between empagliflozin and FG. We report a case of FG in a patient during a period of good glycemic management following treatment with empagliflozin. We recommend further awareness of this relationship and suggest the need for additional research.

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Section: Discussionmentioning

confidence: 99%

Fournier’s Gangrene in a Patient with Type 2 Diabetes Mellitus Treated with Empagliflozin: A Case Report

Nagano

Yakame

Aoki

et al. 2019

Drug Saf - Case Rep

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“…Despite the late stage presentation and the limited resources, the management of this case was successful, although it required a long-time admission and it absorbed limited human and economic resources. This is not the first case reported as others have been documented in recent years, especially in industrialised countries [10][11][12][13]. However, we present here the first systematic review on this topic.…”

Section: Discussionmentioning

confidence: 53%

Empagliflozin Use and Fournier’s Gangrene: Case Report and Systematic Literature Review

Antunes

León

Pizzol³

et al. 2021

Surgeries

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Background: Fournier’s gangrene (FG) is a rare necrotising soft tissue infection localised in the genital areas with possible dramatic outcomes. Recently, sodium glucose co-transporter-2 (SGLT2) inhibitors were identified as a risk factor. Methods: We present a case report of a 57-year-old female patient with type 2 diabetes mellitus (T2DM) in treatment with empagliflozin which led to the development of FG. Moreover, we performed a systematic review assessing the association between empagliflozin use and FG. Results: The female patient with 15-years treated diabetes presented a massive FG after 6 months from starting empagliflozin. Over the period of two months, she was successfully treated in a low-income setting. The systematic review included two studies with a total of 9915 participants. Although no participant had FG, there was an increased rate of urinary and genital infection in patients treated with empagliflozin compared to those treated with other antidiabetics or placebo. Conclusions: FG should be considered as a possible complication in patients using SGLT2. Patients should be educated to report early signs of genital infection and healthy behaviours as well as a balanced diet should be promoted to aid in the prevention of FG.

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“…A systematic review of the literature for case reports of FG associated with the use of SGLT2 inhibitors resulted in 1,203 articles, of which nine were identified as case reports of FG associated with the use of an SGLT2 inhibitor (Figure 2) (20)(21)(22)(23)(24)(25)(26)(27)(28). Characteristics of the nine case reports are presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Lengths of stay varied between 12 days and 9 weeks, when longer duration of treatment was required either because of prolonged use of antibiotics or other clinical complications. Clinical courses were most often complicated by sepsis, uncontrolled diabetes requiring insulin management, multiple surgical re-explorations with further debridement, or prolonged intravenous antibiotics use (20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Resultsmentioning

confidence: 99%

Sodium–Glucose Cotransporter 2 Inhibitor Use Associated With Fournier’s Gangrene: A Review of Case Reports and Spontaneous Post-Marketing Cases

2022

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Background Sodium–glucose cotransporter 2 (SGLT2) inhibitors are effective for glycemic control and have demonstrated cardiorenal benefits. The U.S. Food and Drug Administration (FDA) released a boxed warning in 2018 regarding the potential development of Fournier’s gangrene (FG) with the use of SGLT2 inhibitors. FG is a serious perineal infection with a mortality rate of up to 88% in some cases. Objectives To report spontaneous post-marketing cases from the FDA Adverse Event Reporting System (FAERS) database and case reports from the literature of FG associated with the use of SGLT2 inhibitors and to determine whether correlations exist with specific agents. Methods A search of the FAERS database was conducted to identify reported cases of FG associated with the use of any FDA-approved SGLT2 inhibitor between 1 March 2013 and 30 June 2020. Additionally, a literature search was conducted of PubMed, Embase, and the Cochrane library using PRISMA guidelines to identify case reports of FG with the use of SGLT2 inhibitors up to 9 October 2020. Results A total of 491 cases from the FAERS database were included for review. Descriptive analysis depicted more cases in the empagliflozin, canagliflozin, and dapagliflozin groups than in the ertugliflozin group. Nine case reports were included from the literature review; four attributed to dapagliflozin, three to empagliflozin, and two to canagliflozin. The median ages from cases reported in the FAERS database and from the literature review were 54 and 52 years, respectively. In both datasets, males had a higher incidence of FG than females. Additional data reported include clinical outcomes and concomitant antihyperglycemic medications. Conclusion Consistent findings are noted in this systematic review and warrant further investigation to elucidate the association between SGLT2 inhibitor use and the development of FG. These results may drive enhanced prescribing patterns to consider patient-specific risk factors and timely monitoring, especially as more indications are approved related to these medications’ cardiorenal protective properties.

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Early Presentation of a Rare Complication of Sodium-Glucose Cotransporter-2 Inhibitors 10 Days After Initiation: Case Report and Literature Review

Cited by 7 publications

References 14 publications

Fournier’s Gangrene in a Patient with Type 2 Diabetes Mellitus Treated with Empagliflozin: A Case Report

Fournier’s Gangrene in a Patient with Type 2 Diabetes Mellitus Treated with Empagliflozin: A Case Report

Empagliflozin Use and Fournier’s Gangrene: Case Report and Systematic Literature Review

Sodium–Glucose Cotransporter 2 Inhibitor Use Associated With Fournier’s Gangrene: A Review of Case Reports and Spontaneous Post-Marketing Cases

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