Research Fellow, Hematology and Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Endocrinology, Augusta University Medical College of Georgia, Augusta, Georgia, USA.
BMJ Case Rep. 2022 Jul 11;15(7):e250942. doi: 10.1136/bcr-2022-250942.
A man in his late 50s, with uncontrolled type 2 diabetes mellitus (T2DM) and morbid obesity, presented to the hospital with complicated epididymo-orchitis. The onset of symptoms (scrotal pain, erythema and swelling) occurred after the use of empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, for 2 months. His baseline antidiabetic medications were insulin, glipizide and metformin. Initially, he had failed treatment of epididymo-orchitis with oral levofloxacin for 3 weeks, followed by 2 weeks of doxycycline therapy. At the presentation to the hospital, an ultrasound of the scrotum revealed scrotal and right testicular abscess. The patient underwent right inguinal orchiectomy. Postoperatively, pus culture was positive for and , and hence, he was treated with oral antibiotics including high-dose antifungal medications. Adequate wound care and regular follow-up demonstrated resolution of infection. This case highlights the risk of severe urogenital infection associated with the use of SGLT2 inhibitors in the setting of uncontrolled T2DM.
一位 50 多岁的男性，患有 2 型糖尿病（T2DM）且肥胖，因并发附睾炎-睾丸炎而到医院就诊。症状（阴囊疼痛、红斑和肿胀）出现于使用钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂恩格列净 2 个月后。他的基础降糖药物为胰岛素、格列吡嗪和二甲双胍。最初，他口服左氧氟沙星治疗 3 周后未能治愈附睾炎-睾丸炎，随后又接受了 2 周的多西环素治疗。在就诊时，阴囊超声显示阴囊和右侧睾丸脓肿。患者接受了右侧腹股沟睾丸切除术。术后，脓液培养出 和 ，因此，他接受了包括大剂量抗真菌药物在内的口服抗生素治疗。充分的伤口护理和定期随访显示感染得到了治愈。该病例强调了在未控制的 T2DM 情况下使用 SGLT2 抑制剂与严重泌尿生殖系统感染相关的风险。
