Bitter sweet: Fournier’s Gangrene and SGLT2 inhibitors

Abstract

Diabetes mellitus, especially type 2 is becoming the biggest epidemic of the 21st century affecting more than 415 million adults globally and expected to increase to more than 640 million adults by 2040. Patients with diabetes are at high risk for adverse outcomes, notably cardiovascular disease with an increased risk of death. In fact, the 2018 Canadian Diabetes Association (CDA) guidelines have updated the type 2 diabetes management algorithm; if the patient has clinical cardiovascular disease, an antihyperglycemic agent with demonstrated cardiovascular (CV) benefit should be added. There is a growing armamentarium of therapies with Health Canada-approved CV benefit include two from the sodium-glucose co-transporter 2 (SGLT2) inhibitors class namely Canagliflozin and empagliflozin. Despite their many advantages, the Food and Drug Administration (FDA) issued a black box warning for associated necrotizing fasciitis of the perineum in diabetes treated with SGLT2 inhibitors.  This case report highlights a case of Fournier’s gangrene (FG) in a male treated with empagliflozin for type 2 diabetes.