Miao Vera Y, Wijaya Marlene, Fischer Gayle, Saunderson Rebecca B
Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.
J Low Genit Tract Dis. 2024 Oct 1;28(4):371-376. doi: 10.1097/LGT.0000000000000839. Epub 2024 Sep 2.
The authors present a case series of severe vulvovaginal candidiasis in postmenopausal women using sodium-glucose cotransporter-2 inhibitor (SGLT2i) medications for the management of their diabetes mellitus.
Twenty-four cases from a private vulvovaginal specialist clinic are described.
All 24 patients were referred with severe and persistent vulvar pruritus, pain, and erythema. Examination findings varied between patients and included erythema, edema, erosions, adherent white discharge, and fissuring, which were extensive and often involved the mons pubis, labia majora, and extended to the perineum and perianal region, mimicking psoriasis and/or irritant dermatitis. The clinical presentation in this postmenopausal group hindered a timely diagnosis, resulting in a delay in appropriate management. Fortunately, all patients improved on oral antifungal treatment, and in those that ceased their SGLT2i medication, there was resolution of the condition.
While candidiasis is reported to occur with SGLT2i, severe genital mycotic infections are not yet a well-recognized adverse effect and may be missed. The presentation in these cases was persistent and severe. Clinicians should have a high index of suspicion in postmenopausal women presenting with vulvar pain, pruritus, and extensive erythema that mimics psoriasis or irritant dermatitis, if they are on SGLT2i therapy.
作者介绍了一系列绝经后女性严重外阴阴道念珠菌病的病例，这些女性使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）药物来治疗糖尿病。
描述了一家私立外阴阴道专科诊所的24个病例。
所有24例患者均因严重且持续的外阴瘙痒、疼痛和红斑前来就诊。患者的检查结果各不相同，包括红斑、水肿、糜烂、附着的白色分泌物和皲裂，范围广泛，常累及耻骨联合、大阴唇，并延伸至会阴和肛周区域，类似银屑病和/或刺激性皮炎。绝经后组的临床表现妨碍了及时诊断，导致适当治疗的延迟。幸运的是，所有患者口服抗真菌治疗后病情均有改善，停用SGLT2i药物的患者病情得到缓解。
虽然据报道SGLT2i会引发念珠菌病，但严重的生殖器真菌感染尚未被充分认识为一种不良反应，可能会被漏诊。这些病例的表现持续且严重。对于接受SGLT2i治疗且出现外阴疼痛、瘙痒和类似银屑病或刺激性皮炎的广泛红斑的绝经后女性，临床医生应高度怀疑。
