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Fournier Gangrene SGLT2i — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseFournier Gangrene SGLT2iESENeph

A 60-year-old man with diabetes and CKD G3b has HbA1c 55 mmol/mol on Metformin and Dapagliflozin. He develops a foul-smelling perineal discharge with pain and swelling. Examination shows spreading erythema and crepitus around the scrotum. What is the diagnosis and its relevance to his medication?

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Correct answer: A — Fournier gangrene – a rare but serious complication associated with SGLT2 inhibitor use

Fournier gangrene (necrotising fasciitis of the perineum/genitalia) is a rare but serious complication that has been associated with SGLT2 inhibitor use. The MHRA and FDA have issued safety alerts. The glycosuria caused by SGLT2i creates a warm, glucose-rich environment predisposing to perineal infections. This is a surgical emergency requiring urgent debridement, broad-spectrum IV antibiotics, and SGLT2i discontinuation. Diabetes itself is a risk factor, so the association with SGLT2i may be partly confounded.

Reference: MHRA 2019 – SGLT2i Safety Alert; FDA 2018 – Fournier Gangrene Warning