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Fournier Gangrene — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineFournier GangreneRACP Adult Medicine

A 50-year-old woman with type 2 diabetes on empagliflozin develops Fournier gangrene (necrotising fasciitis of the perineum). She presents with perineal pain, swelling, crepitus, and systemic sepsis. What is the critical management priority?

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Correct answer: B — Emergency surgical debridement

Fournier gangrene is a rare but recognised complication of SGLT2 inhibitors (TGA safety alert issued). It is a necrotising fasciitis of the perineum/genitalia that is rapidly fatal without emergency surgical debridement – the single most critical intervention. Broad-spectrum IV antibiotics (piperacillin-tazobactam + clindamycin + vancomycin) are commenced concurrently. SGLT2 inhibitor must be permanently ceased. The increased glucose in urine provides a medium for bacterial growth.

Reference: TGA – 2024 – SGLT2 Inhibitor Fournier Gangrene Safety Alert; eTG – 2025 – Antibiotic Guidelines