Elbeddini Ali, Gallinger Jodi, Davey Michelle, Brassard Stephane, Gazarin Mohammed, Plourde Frida, Aly Ahmed
Department of Clinical Pharmacy, Winchester District Memorial Hospital, Winchester, Ontario, Canada.
Department of Clinical Pharmacy, University of Waterloo Pharmacy School, Waterloo, Ontario, Canada.
Am J Case Rep. 2020 Feb 24;21:e920115. doi: 10.12659/AJCR.920115.
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of antihyperglycemic medications associated with an increased risk of urinary and genital infections due to their glycosuric effects. In 2018, the FDA issued a safety alert warning that multiple cases of Fournier's Gangrene (FG), a severe genital infection, had been reported in patients taking SGLT2 inhibitors. CASE REPORT We present a case of 72-year-old male with type II diabetes mellitus who developed FG while taking the SGLT2 inhibitor canagliflozin. Besides diabetes and canagliflozin use, his other risk factors were his age, gender, and remote history of radiotherapy for prostate cancer. He presented to the Emergency Department (ED) multiple times complaining of rectal pain and was admitted for a possible diagnosis of prostatitis. During his stay, he developed leukocytosis, his pain worsened, and examination of the perianal area was consistent with FG. He was treated with multiple surgical debridement procedures and broad-spectrum antibiotics; the source of infection was determined to be a perianal abscess. He stayed in the hospital for 1 month and was discharged home with outpatient wound care and vacuum dressing changes. Canagliflozin was discontinued during the hospital stay. CONCLUSIONS Due to the possible association of FG with SGLT2 inhibitors, patients who present with signs and symptoms consistent with FG should be examined for possible FG and treated promptly.
背景 钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是一类抗高血糖药物，因其糖尿作用而增加了泌尿系统和生殖器感染的风险。2018年，美国食品药品监督管理局（FDA）发布了一项安全警报，警告称在服用SGLT2抑制剂的患者中报告了多例福尼尔坏疽（FG），这是一种严重的生殖器感染。病例报告 我们报告一例72岁的2型糖尿病男性患者，在服用SGLT2抑制剂卡格列净时发生了FG。除了糖尿病和使用卡格列净外，他的其他风险因素包括年龄、性别以及既往前列腺癌放疗史。他多次前往急诊科（ED），主诉直肠疼痛，并因可能的前列腺炎诊断而入院。在住院期间，他出现了白细胞增多，疼痛加剧，肛周区域检查结果与FG相符。他接受了多次手术清创和广谱抗生素治疗；感染源被确定为肛周脓肿。他住院1个月，出院回家后接受门诊伤口护理和负压伤口敷料更换。住院期间停用了卡格列净。结论 由于FG可能与SGLT2抑制剂有关，出现与FG相符的体征和症状的患者应接受FG检查并及时治疗。
