skip to main content

SGLT2i Fournier Gangrene — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateEndocrinology & DiabetesSGLT2i Fournier GangreneRACP Adult Medicine

A 65-year-old man with a 5-year history of type 2 diabetes is commenced on an SGLT2 inhibitor. He develops perineal pain and swelling 4 weeks later. Examination shows necrotic tissue in the scrotum with crepitus. What is this complication?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Fournier gangrene

Fournier gangrene (necrotising fasciitis of the perineum/genitalia) is a rare but serious complication of SGLT2 inhibitors, recognised by the TGA, FDA, and EMA. The increased urinary glucose provides a substrate for bacterial growth. It requires immediate surgical debridement (source control), broad-spectrum IV antibiotics, and SGLT2 inhibitor cessation. Mortality is 20–40% despite treatment. All patients commencing SGLT2 inhibitors should be counselled about this risk.

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