Endocrine Abstracts

Introduction: The Food and Drug Administration (FDA) had issued warnings on the increased risk of diabetic ketoacidosis and Fournier’s gangrene with patients using Sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Herein, we report a case of simultaneous Fournier’s gangrene and diabetic ketoacidosis after initiation of treatment with Empagliflozin.

Case Presentation: We report a case of a 54-year-old woman with type 2 diabetes on empagliflozin presented feeling unwell. Blood glucose level raised at 32.7 and ketones of 2.2 mmol on admission. Blood gas showed acidosis of pH 7.242 (7.35 - 7.45), bicarbonate of 21.2 mEq/l (22 - 26) and base excess of - 6.5 mmol/l (-2 to +2). She was started on diabetes ketoacidosis treatment. Empagliflozin was suspended. Blood results showed raised C-reactive protein of 353 mg/l. She reported new incontinence of both urine and faeces for 2 weeks. Examination revealed perianal fistula, extensive perineal erythema, pus with central necrotic area on left perineum, inflammation of left labia with a patch of necrosis in left groin crease. She was commenced on broad spectrum intravenous antibiotics. CT scan showed marked diffuse subcutaneous fatty infiltration and oedema on the left side of the perineum and left buttock with suspected fluid collection of the left labia measuring 29x14mm, multiple enlarged left inguinal lymph nodes. She underwent surgical drainage and debridement. Histology showed ulceration and necrotizing abscess with fat necrosis which confirmed the diagnosis of Fournier’s gangrene. Humulin M3 twice daily was initiated. She then recovered well.

Conclusion: To our knowledge, only 4 cases reported in the literature worldwide presented with simultaneous Fournier’s gangrene and diabetic ketoacidosis after initiation of treatment with (SGLT2) inhibitors. Health care professionals should be aware of this extremely rare but life-threatening adverse events. They should assess patients for Fournier’s gangrene if suspected.