A 55-year-old man with type 2 diabetes is started on canagliflozin. After 6 weeks he presents with perineal swelling, redness, crepitus, and high fever. What is the most important complication to recognize?

• A Urinary tract infection
• B Scrotal edema from fluid shifts
• C Drug hypersensitivity reaction
• D Fournier's gangrene (necrotizing fasciitis of the perineum) ✓

Explanation

Fournier's gangrene is a rare but life-threatening necrotizing fasciitis of the perineum and genitalia linked to SGLT2 inhibitors and carries an FDA black box warning. The altered urogenital microbiome from glucosuria creates conditions for polymicrobial infection. The classic triad includes perineal pain, fever, and crepitus on palpation indicating subcutaneous gas. Immediate surgical debridement and broad-spectrum antibiotics are required; SGLT2 inhibitor must be stopped.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.