SGLT2i Fournier's Gangrene — EECC MCQ

Correct answer: A — Fournier's gangrene is a very rare but serious adverse effect of SGLT2 inhibitors (FDA/MHRA warning) — the glycosuria creates a favourable environment for genital/perineal bacterial infection; dapagliflozin should be stopped immediately with urgent surgical debridement and broad-spectrum antibiotics

Fournier's gangrene (necrotising fasciitis of the perineum/genital area) is an extremely rare but life-threatening adverse effect associated with SGLT2 inhibitors. The FDA (2018) and MHRA issued safety alerts after post-marketing reports. The mechanism: SGLT2i-induced glycosuria creates a glucose-rich environment in the genitourinary tract, promoting bacterial overgrowth and ascending infection. While extremely rare (estimated 1 in 10,000-20,000 patient-years), Fournier's gangrene carries 20-40% mortality. Risk factors: diabetes, obesity, immunosuppression, prior genital infections. Management: (1) stop SGLT2i immediately; (2) emergency surgical debridement (the definitive treatment); (3) broad-spectrum IV antibiotics (covering aerobic and anaerobic organisms); (4) the SGLT2i should NOT be restarted after recovery. All patients on SGLT2 inhibitors should be counselled about genital hygiene and warned to seek urgent medical attention for perineal pain, swelling, or erythema.

Reference: FDA/MHRA Safety Alerts; ESC (2023): HF Guidelines