A complication due to the medicine she was using to treat her disease and doctors need to be more aware of the dangers involved, a new study shows.
A 62-year-old female with a background of well controlled type 2 diabetes mellitus (T2DM) reported vulval pain and swelling, progressing rapidly over 24 hours.
A diagnosis of Fournier’s gangrene was made which is a rare, life-threatening bacterial infection of the reproductive area or genitalia of a man or a woman. The danger of death is as high as between 20% and 30%.
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Urgent debridement or tissue from the wound was removed. Doctors do this to help a wound heal. Broad-spectrum antimicrobials were commenced which is a substance that kills microorganisms such as bacteria or mold, or stops them from growing and causing disease.
The study, Fournier’s Gangrene Associated with SGLT-2 Inhibitor Usem in this month’s Irish Medical Journal, found that the woman was experiencing a medical emergency due to the medicine she was taking.
There is no National Diabetes Registry of people living with diabetes in Ireland, therefore all national estimates might not be fully accurate. According to Diabetes Ireland the Irish estimate of those living with Type 2 diabetes is 234,398 and 28,800 with Type 1.
The woman was admitted to a tertiary hospital for management following a coronary-artery-bypass-grafting. Her background history was otherwise significant for her form of diabetes was well controlled.
On day two of her hospital stay she reported severe pain in the groin. Following gynaecology review, the patient was diagnosed with a vulval abscess and commenced on intravenous treatment. Over the next 24hours, the patient deteriorated with septic shock requiring transfer to the Intensive Care Unit (ICU) for vasopressor support as her condition had drastically deteriorated.
The patient returned to theatre every 48 hrs for wound review until day 21 post-operatively. The patient was discharged from the ICU to the ward after 19 days.
On admission to ICU the patient's medications were reviewed, and it was noted she was receiving an SGLT-2 inhibitor (type of medicine), which had been commenced over two years previously. This medicine was discontinued indefinitely.
Authors of the St James’ Hospital study highlighted: “Diabetes, alcohol excess, elevated BMI and local trauma are known risk factors for Fournier’s gangrene.
“More recently, an association with SGLT-2 inhibitor use has been recognised. When prescribing (such medicine), physicians should counsel patients that they are at increased risk of urogenital infections.
“Physicians should be aware of the association between SGLT-2 inhibitors and Fournier’s gangrene, and SGLT-2 inhibitors should be stopped indefinitely if Fournier’s gangrene occurs”.
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