Fournier’s Gangrene: A Coexistence or Consanguinity of SGLT-2 Inhibitor Therapy

Abstract

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a relatively new class of medications used for the management of type II diabetes mellitus targeting the kidneys. Within the last decade, several warnings have been issued regarding the development of severe genitourinary infections, including necrotizing fasciitis, or Fournier's gangrene, in those with pre-existing type II diabetes and concomitant use of this drug class.Objective: The purpose of this review is to highlight and discuss the factors contributing to the development of Fournier's gangrene, its pathogenesis, and a review of existing literature describing patient outcomes, treatment, and future directions regarding early detection of this complication.Methods: Articles and studies addressing effective treatment adherence and key factors contributing to Fournier's gangrene with SGLT2 inhibitors were identified by effective keyword searches in PubMed Central, Google Scholar, and Cochrane, as well as the references found within these articles.Results: Using the keywords provided, 55 case reports, review articles, and meta-analysis reports written within the last 20 years were utilized as the source of the data presented in this systematic review article.

Fournier's Gangrene in a Patient With CKD Without Diabetes Possibly Related to Sodium-Glucose Cotransporter 2 Inhibitor Therapy

“…Our patient with CKD but without diabetes mellitus presented with Fournier's gangrene on SGLT2-inhibitor treatment. 3 , 4 To date, with more than 90,000 patients under SGLT2-inhibitor therapy investigated in RCTs, according to the pharmacovigilance departments of AstraZeneca and Boehringer Ingelheim, this is the first report of a Fournier's gangrene on SGLT2-inhibitor treatment in a patient with CKD without diabetes. Key teaching points of this case are presented in Table 1 .…”

Insight on Infections in Diabetic Setting

“…More recently, several infections have been supposed to rely on newly introduced therapies. As an example, sodium-glucose co-transport 2 inhibitors (SGLT2-i) are associated with the occurrence of urinary and genital tract infections [ 15 , 16 , 17 ]. Moreover, among infections commonly associated with hospitalization, including urinary tract and skin infections, pneumonias, and surgical infections, the presence of DM confers an increased risk ( Figure 1 ).…”

Fournier's gangrene caused by urethral manipulation in a seven-year-old boy: A case report

“…The main organisms associated with Fournier's gangrene are Escherichia coli and Bacteroides fragilis , which cause extensive tissue damage by releasing collagenase enzymes. 2 …”

“…Pain and discomfort in the genitalia and perineum are the initial presentation of FG, fever, palpitation erythema, swelling, crepitus and purulent discharge may be evident. 2 …”

“…The goal of timely treatment is to save the patient from sepsis and then minimize sexual and urinary complications. 2 …”