Case Report: Fournier Gangrene in a Diabetic Patient Using Dapagliflozin

Year 2025, Volume: 16 Issue: 2, 48 - 52, 29.06.2025

Ceren Adali , Beyza Torun , Omer Zuhtu Yondem , Alper Bilal Özkardeş Ayçe Çeliker

Abstract

Introduction: Fournier gangrene is a rare but severe necrotizing infection of the perineal region, requiring immediate medical attention. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors, while effective in managing diabetes and providing cardiovascular benefits, have been linked to rare but serious adverse effects. In 2018, regulatory warnings highlighted a potential connection between these drugs and Fournier gangrene, though reported cases remain scarce.
Case Report: This report details the case of a 59-year-old diabetic female who developed Fournier gangrene during dapagliflozin treatment. The patient presented with extensive perineal necrosis necessitating urgent surgical debridement and initiation of broad-spectrum antibiotics. Microbiological analysis identified Escherichia coli as causative pathogen. Intensive wound management and insulin adjustments led to significant clinical improvement, and the patient was discharged after 24 days.
Conclusion: The possible link between SGLT-2 inhibitors and Fournier gangrene remains under investigation. While glucosuria induced by these medications may heighten the risk of infections, the presence of comorbidities such as diabetes and immunosuppression are likely contributing factors. This case emphasizes the complexity of determining causality. Clinicians prescribing SGLT-2 inhibitors should be vigilant for signs of rare infections like Fournier gangrene, especially in patients with multiple risk factors. Prompt diagnosis and aggressive treatment are critical for patient recovery.

Keywords

dapagliflozin , fournier gangrene , sodium-glucose cotransporter-2 inhibitors , case report

Olgu Sunumu: Dapagliflozin Kullanan Diyabetik Bir Hastada Fournier Gangreni

Abstract

Giriş: Fournier gangreni, perineal bölgede görülen, nadir ancak ciddi bir nekrotizan enfeksiyondur ve acil tıbbi müdahale gerektirir. Sodyum-glukoz kotransportör 2 (SGLT-2) inhibitörleri, diyabetin yönetiminde etkili olup kardiyovasküler faydalar sağlarken, nadir fakat ciddi yan etkilerle ilişkilendirilmiştir. 2018 yılında yayınlanan düzenleyici uyarılar, bu ilaçlar ile Fournier gangreni arasında potansiyel bir bağlantıya işaret etmiş, ancak bildirilen vaka sayısı düşük kalmıştır.
Olgu Sunumu: Bu yazıda, dapagliflozin tedavisi sırasında Fournier gangreni gelişen 59 yaşında diyabetik bir kadın hasta sunulmaktadır. Hasta, geniş perineal nekroz ile başvurmuş; acil cerrahi debridman ve geniş spektrumlu antibiyotik tedavisi uygulanmıştır. Mikrobiyolojik analizde Escherichia coli, enfeksiyona neden olan patojen olarak tanımlanmıştır. Yoğun yara bakımı ve insülin düzenlemeleri sayesinde belirgin klinik iyileşme sağlanmış ve hasta 24 gün sonra taburcu edilmiştir.
Sonuç: SGLT-2 inhibitörleri ile Fournier gangreni arasındaki olası bağlantı hala araştırılmaktadır. Bu ilaçların neden olduğu glukozüri, enfeksiyon riskini artırsa da, diyabet ve immünsupresyon gibi komorbiditelerin de önemli katkıda bulunması muhtemeldir. Bu vaka, nedenselliğin belirlenmesindeki karmaşıklığı vurgulamaktadır. SGLT-2 inhibitörlerini reçete eden klinisyenler, özellikle birden fazla risk faktörü taşıyan hastalarda Fournier gangreni gibi nadir enfeksiyonların belirtilerine karşı dikkatli olmalıdır. Erken tanı ve agresif tedavi, hasta iyileşmesi için hayati öneme sahiptir.

Keywords

dapagliflozin , olgu sunumu , fournier gangreni , sodyum-glukoz kotransporter-2 inhibitörleri

References

• 1. Nagano Y, Kashiwagi Yakame N, Aoki H, Yamakawa T, Kondo NI. Fournier’s gangrene in a patient with type 2 diabetes mellitus treated with empagliflozin: A case report. Drug Saf Case Rep 2019; 6: Article 11. https://doi.org/10.1007/s40800-019-0105-8
• 2. Suciu IM, Grelus A, Cozlac AR, Suciu BS, Stoica S, Luca S, et al. Fournier’s gangrene as an adverse event following treatment with sodium glucose cotransporter 2 inhibitors. Medicina 2024; 60(5): 837. https://doi.org/10.3390/medicina60050837
• 3. Vallon V. State-of-the-Art Review: Mechanisms of Action of SGLT2 Inhibitors and Clinical Implications. Am J Hypertens 2024; 37(11): 841–852. https://doi.org/10.1093/ajh/hpae092
• 4. Vargo E, Leone G, Barat O, Yunker A, Parekh N. A case of Fournier’s gangrene following a large-volume hydrocelectomy in a diabetic patient managed with SGLT-2 inhibitor therapy. Urol Case Rep 2021; 39: 101834. https://doi.org/10.1016/j.eucr.2021.101834
• 5. Khokhar F, Hernandez C, Mahapatra R. Fournier’s gangrene in an HIV-positive patient on empagliflozin for the treatment of diabetes mellitus. Cureus 2022; 14(6): e26083. https://doi.org/10.7759/cureus.26083
• 6. Çalbay A, Bayramoğlu A, Karadeniz E. What are the alternatives to the LRINEC score in identifying necrotizing soft tissue infections in the emergency department? Eurasian J Crit Care 2022; 4(2): 41-46. https://doi.org/10.55994/ejcc.1135938
• 7. Elbeddini A, Gallinger J, Davey M, Brassard S, Gazarin M, Plourde F, et al. A case of Fournier’s gangrene in a patient taking canagliflozin for the treatment of type II diabetes mellitus. Am J Case Rep 2020; 21: e920115. https://doi.org/10.12659/AJCR.920115
• 8. Elbeddini A, Tayefehchamani Y, Davey M, Gallinger J, Hooda N, Aly A, et al. Fournier’s gangrene with dapagliflozin in a rural hospital: A case report. BMJ Case Rep 2021; 14(2): e237784. https://doi.org/10.1136/bcr-2020-237784
• 9. Ellegård L, Prytz M. Fournier’s gangrene under SGLT-2 inhibitor therapy: A literature review and case report. Int J Surg Case Rep 2020; 77: 692–694. https://doi.org/10.1016/j. ijscr.2020.11.100
• 10. Jahir T, Hossain S, Bagum M, Saidi A, Risal R, Schmidt M. A rare but life-threatening case of Fournier’s gangrene caused by sodium-glucose cotransporter-2 (SGLT2) inhibitor, empagliflozin. Cureus 2022; 14(9): e29264. https://doi.org/10.7759/cureus.29264
• 11. Kumar S, Costello AJ, Colman PG. Fournier’s gangrene in a man on empagliflozin for treatment of type 2 diabetes. Diabet Med 2017; 34(11): 1646–1648. https://doi.org/10.1111/dme.13508