Fournier坏疽(FG)是一种罕见但严重的软组织感染,导致会阴坏死,肛周和泌尿生殖系统。这种感染可以在体内迅速传播并导致多器官衰竭,感染性休克,和死亡。这种威胁生命的感染通常是由多微生物剂引起的,如A组-β溶血性链球菌-化脓性链球菌,金黄色葡萄球菌,大肠杆菌,肺炎克雷伯菌,Proteus,和厌氧菌,如类杆菌和梭状芽胞杆菌。与FG发展相关的危险因素是肥胖,不受控制的糖尿病,缺乏教育,个人卫生差,尤其是在生殖器区域,真菌感染史,复发性尿路感染,吸烟,免疫抑制,和药物。2018年,美国食品和药物管理局(FDA)发布了关于钠-葡萄糖共转运蛋白2(SGLT2)抑制剂的安全警告,在2型糖尿病患者中引起FG的罕见但严重的不良结局。已经确定,SGLT-2抑制剂引起的尿葡萄糖浓度增加为泌尿和生殖器区域的感染生长创造了合适的环境,导致FG的发展。在这里,我们介绍了一例在开始使用SGLT2抑制剂四个月后,有2型糖尿病既往史,生殖器酵母感染复发史的肥胖女性中危及生命的FG,empagliflozin.本研究旨在了解FG与SGLT-2抑制剂之间的关系。总体而言,SGLT2抑制剂的益处超过了许多风险,因此,提高临床医生的警觉,保持高度怀疑并专注于SGLT2抑制剂的安全使用,特别是在开SGLT-2抑制剂之前和之后,密切随访,以防止其严重和危及生命的紧急情况,如Fournier坏疽和坏死性筋膜炎。
Fournier\'s gangrene (FG) is a rare but severe infection in the soft tissue, leading to necrosis in the perineum, perianal and genitourinary area. This infection can spread rapidly in the body and lead to multi-organ failure, septic shock, and death. This life-threatening infection is usually caused by polymicrobial agents like Group A - Beta Hemolytic Streptococcus- Streptococcus pyogenes, Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia, Proteus, and anaerobes like Bacteroides and Clostridium perfringes. Risk factors related to the development of FG are obesity, uncontrolled diabetes, lack of education, poor personal hygiene, especially in the genital region, history of fungal infection, recurrent urinary tract infection, smoking, immunosuppression, and medication. In 2018, a safety warning was issued by The U.S. Food and Drug Administration (FDA) on sodium-glucose cotransporter-2 (SGLT2) inhibitors, causing a rare but serious adverse outcome of FG in patients with type 2 diabetes mellitus. It is established that the increased urinary glucose concentration caused by SGLT-2 inhibitors creates a suitable environment for the growth of the infection in the urinary and genital area, leading to the development of FG. Here we present a
case of life-threatening FG in an obese female with a past medical history of type 2 diabetes mellitus with recurrent history of genital yeast infection four months after starting an SGLT2 inhibitor, empagliflozin. This study aims to understand the relationship between the FG and SGLT-2 inhibitor, overall the benefits of SGLT2 inhibitors outweighs the risk manyfold, therefore, raising awareness among clinician to be vigilant, keep a high index of suspicion and focus on the safe use of SGLT2 inhibitors, especially before and after prescribing SGLT-2 inhibitor with a close follow-up to prevent its serious and life-threatening emergency like Fournier\'s gangrene and necrotizing fasciitis.