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Sodium-glucose cotransporter 2 inhibitor-associated severe epididymo-orchitis
Rahul Mishra1, Ghada Elshimy2, Lakshmi Kannan3
1Research Fellow, Hematology and Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
BMJ Case Reports
|July 11, 2022
Summary
Sodium-glucose cotransporter 2 (SGLT2) inhibitors may increase the risk of severe genitourinary infections in patients with uncontrolled type 2 diabetes mellitus. This case report details a patient who developed a severe scrotal abscess after starting empagliflozin.
Area of Science:
- Endocrinology
- Urology
- Infectious Diseases
Background:
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly used for type 2 diabetes mellitus (T2DM).
- Uncontrolled T2DM is associated with an increased risk of infections.
- Empagliflozin is an SGLT2 inhibitor used to manage T2DM.
Observation:
- A patient with uncontrolled T2DM and morbid obesity developed epididymo-orchitis after 2 months of empagliflozin therapy.
- Initial antibiotic treatments with levofloxacin and doxycycline were unsuccessful.
- Scrotal ultrasound revealed a scrotal and right testicular abscess, necessitating right inguinal orchiectomy.
Findings:
- Postoperative pus culture identified Enterococcus faecalis and Candida glabrata.
- Treatment with oral antibiotics and high-dose antifungals led to infection resolution.
- This case suggests a potential link between SGLT2 inhibitor use and severe urogenital infections.
Implications:
- Clinicians should be aware of the potential risk of severe urogenital infections in T2DM patients using SGLT2 inhibitors.
- Close monitoring for signs of infection is crucial in patients on SGLT2 inhibitors, especially those with poorly controlled diabetes.
- Further research is warranted to elucidate the mechanisms and prevalence of SGLT2 inhibitor-associated genitourinary infections.
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