Fournier’s Gangrene under Sodium–Glucose Cotransporter-2 Inhibitors Therapy in Gynecological Patients

Abstract

Fournier’s gangrene (FG) is a serious pathology of the soft tissues and fascia of the perineum and genital region with a high morbidity and mortality rate. In recent years, the SGLT-2 inhibitor oral antidiabetic has been related to this entity. According to the new warnings from the main drug agencies, a compilation of cases has been initiated to establish or deny a possible causal relationship. Most of these cases have been reported in men. However, it is important not to underestimate this entity in the gynecological field, since it is extremely serious and requires intense and rapid aggressive treatment based on surgery and empiric antibiotherapy. Later, some cares are needed to involve surgical reconstruction of the defects introduced by debridement. As a result of the low incidence of FG, clinical trials’ data may be insufficient to robustly assess this issue because of the limited numbers of participants. Real-world evidence may help to clarify the association between SGLT2i and FG. The aim of this review is to describe and compare the reported cases of GF in diabetic women who received SGLT2 inhibitors as antiglycemic agents.

Clinical features and treatment outcomes of Fournier's gangrene in a single tertiary emergency hospital: Simplified Fournier's Gangrene Severity Index score is a predictor for death

“…Eight patients had chronic kidney disease, and 23 patients had diabetes mellitus. Although a meta-analysis failed to clarify the relationship between sodium-glucose cotransporter-2 (SGLT-2) inhibitor and FG, there exist several reports on FG caused by SGLT-2 inhibitor (17,18). Importantly, no patient was prescribed a SGLT-2inhibitor inhibitor in this study.…”

Genital gangrene in a patient with type II diabetes mellitus, treated with dapagliflozin: a case report

“…Biochemical studies such as WBC will be an indicator during diagnosis and clinical presentation. After observing several cases, we concluded that specific parameters such as low albumin, high (BUN) blood urea nitrogen, low hematocrit, hypercalcemia, and increased serum lactate indicate a high mortality rate (Serrano et al 2022).…”

A contemporaneous narrative review of Fournier’s gangrene

“…29,30 Interestingly, some studies note a higher incidence of FG among women who use these antidiabetic classes of drugs. 31 Renal function is an important prognostic indicator, and renal dysfunction is associated with higher mortality. 9 Renal failure and kidney disease can also predispose to many fatal diseases and infections.…”