{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:37:51Z","timestamp":1789558671314,"version":"build-2803163510"},"reference-count":7,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,10,17]],"date-time":"2017-10-17T00:00:00Z","timestamp":1508198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sodium\u2010glucose cotransporter 2 (<jats:styled-content style=\"fixed-case\">SLGT<\/jats:styled-content>2) inhibitors has been associated with an increased risk of genital infections secondary to increased glycosuria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>We report a case of a 41\u2010year\u2010old man with type 2 diabetes treated with empagliflozin and metformin who presented with scrotal swelling. He described multiple preceding episodes of genital thrush for which he self\u2010administered over\u2010the\u2010counter anti\u2010fungal treatment. On examination, he was afebrile and hemodynamically stable. Perineal examination revealed grossly swollen and indurated scrotum with bilateral inguinal lymphadenopathy. Investigations showed elevated inflammatory markers and HbA1c of 99 mmol\/mol (11.2%). Computed tomography revealed features consistent with Fournier's gangrene. He underwent emergency exploration and debridement under anaesthetic with a later return to theatre for further exploration, washout and application of a vacuum dressing. He then received a split skin graft to his perineum. He required a 2\u2010week course of intravenous antibiotics and was discharged home on oral antibiotics. Empagliflozin was ceased on admission and he was commenced on a basal bolus insulin regimen for glycaemic optimisation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is a wide clinical spectrum of genital infections associated with <jats:styled-content style=\"fixed-case\">SGLT<\/jats:styled-content>2 inhibitors with most being generally mild and easily treated. However, risk factors such as diabetes, obesity, immunosuppressed states, smoking, alcohol abuse and end\u2010stage renal or liver failure may increase the risk of potentially more severe infections such as Fournier's gangrene. Timely cessation of <jats:styled-content style=\"fixed-case\">SGLT<\/jats:styled-content>2 inhibitors in individuals with multiple risk factors may help prevent progression to more severe genital infections.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13508","type":"journal-article","created":{"date-parts":[[2017,9,9]],"date-time":"2017-09-09T03:56:42Z","timestamp":1504929402000},"page":"1646-1648","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Fournier's gangrene in a man on empagliflozin for treatment of Type\u00a02 diabetes"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9134-3671","authenticated-orcid":false,"given":"S.","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology Royal Melbourne Hospital Parkville VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. J.","family":"Costello","sequence":"additional","affiliation":[{"name":"Department of Urology Royal Melbourne Hospital Parkville VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. G.","family":"Colman","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology Royal Melbourne Hospital Parkville VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,17]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-3048"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2014.08.063"},{"key":"e_1_2_7_4_1","first-page":"405","article-title":"Deep tissue infection of the perineum; case report and literature review of Fournier gangrene","volume":"62","author":"Faria SN","year":"2016","journal-title":"Can Fam Physician"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200308000-00005"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu444"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.203.3.9169717"},{"key":"e_1_2_7_8_1","unstructured":"ChiW Lim\u2010TioS.Fournier's Syndrome: a life\u2010threatening complication of SGLT2 inhibition in poorly controlled diabetes mellitus[abstract]. Australian Diabetes Society (ADS) and Australian Diabetes Educators Association (ADEA) 2016 Annual Scientific Meeting; 24\u201326th August 2016; Gold Coast Australia. Abstract number 265."}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdme.13508","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.13508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T19:35:32Z","timestamp":1696275332000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.13508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,17]]},"references-count":7,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1111\/dme.13508"],"URL":"https:\/\/doi.org\/10.1111\/dme.13508","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,17]]},"assertion":[{"value":"2017-09-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-10-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}