Fournier’s gangrene under SGLT-2 inhibitor therapy: A literature review and case report

INTRODUCTION: Fournier’s gangrene is a rare, life-threatening necrotizing infection of the perineum. In 2018, the U.S. Food and Drug Administration (FDA) issued a warning regarding a possible connection between Fournier’s gangrene and new oral anti-diabetic drugs called SGLT-2 inhibitors. There are only a few published case reports of Fournier’s gangrene in patients treated with SGLT-2 inhibitors and a total of 55 patients reported by the FDA to date. PRESENTATION OF CASE: We report a case of Fournier’s gangrene in a patient with multiple risk factors, including diabetes type 2, smoking, obesity and immunosuppression. DISCUSSION: Further studies are needed to determine whether or not it is the SGLT-2 inhibitor itself that increases the risk of Fournier’s gangrene, or the fact that the patients receiving this kind of drug is a subgroup of patients with multiple risk factors. CONCLUSION: New oral anti-diabetic drugs, SGLT-2 inhibitors, may be associated with Fournier’s gangrene. Surgeons should become suspicious when patients with diabetes present with perineal symptoms.