Bilateral gangrene of fingers in a patient on empagliflozin: First case report

BACKGROUND: Sodium glucose cotransporter 2 (SGLT2) inhibitors use has been associated with toe amputations and non-healing ulcers and gangrene mostly of lower extremities. There are no case reports about association of Empagliflozin with finger ulcers or gangrene. This is the first case report of Empagliflozin (Jardiance) an SGLT2 inhibitor causing gangrene of fingers and second case in literature about any SGLT2 inhibitor causing gangrene of upper extremity. CASE SUMMARY: A 76-year-old man with type 2 diabetes mellitus sustained minimal trauma to both middle fingers, which started healing. He was started on empagliflozin a week later for management of type 2 diabetes mellitus and started developing gangrene to both middle finger tips along with neuropathic pain which worsened over the course of next four months. Investigations were negative for vascular insufficiency, infection and vasculitis and imaging of hand was normal. Discontinuation of empagliflozin slowed progression of gangrene and caused symptomatic improvement with reduction in neuropathic pain. CONCLUSION: This case report suggests possible association of empagliflozin and finger gangrene and recommends that more research and awareness among clinicians is needed in this area.