Genital gangrene in a patient with type II diabetes mellitus, treated with dapagliflozin: a case report

Sarita Jangra; Bhupinder Bhyan; Shaima KA; Suneha Rani; Ravinder Singh; Harshal Tare

doi:10.31893/multiscience.2023009

Keywords:

fournier gangrene

soft tissue infection

diabetes mellitus

dapagliflozin

Abstract

Fournier gangrene (FG) is a necrotizing soft tissue infection initiated from the genital area or perineum, irrespective of the sex of the patient. A patient presented in the hospital with the chief complaints of inflammation in the scrotum from the past three days, which finally led to a rise in the body temperature. He also observed the discharge from the scrotum for two days. Six days back, he got mildly injured on the left side of his scrotum after falling off from his two vehicle and did not take any treatment. Local examination revealed that the size of the scrotum is slightly enlarged, tender, and oedematous, along with palpable crepitations. There were very observable patches of gangrene all over the scrotum, with no past of Diabetes Mellitus (DM). After the investigation, broad-spectrum antibiotics cefoperazone with sulbactam along with metronidazole were prescribed. After that, the patient was prepared for surgery immediately. After the surgery, the patient was prescribed appropriate antibiotics, followed by a wet dressing. The antibiogram results interpretation confirms that the combined form sulbactam and cefoperazone cause sensitivity towards Staphylococcus Aureusand Escherichia coli. His response was positive towards the treatment. The morbidity and mortality of this medical condition have declined over time due to improvements in diagnostic methods, surgical procedures, powerful antibacterial, and intensive care. This is advised to use an advanced approach while handling FG cases to reduce morbidity and mortality, mainly when concomitant conditions like diabetes and multiple organ failure are present.
References
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2. Czymek R, Frank P, Limmer S, Schmidt A, Jungbluth T, Roblick U, Bürk C, Bruch HP, Kujath P (2010) Fournier's gangrene: is the female gender a risk factor? Langenbeck's archives of surgery 395:173-180. DOI: 10.1007/s00423-008-0461-9
3. Czymek R, Hildebrand P, Kleemann M, Roblick U, Hoffmann M, Jungbluth T, Bürk C, Bruch HP, Kujath P (2009) New insights into the epidemiology and etiology of Fournier's gangrene: a review of 33 patients. Infection, 37:306-312. DOI: 10.1007/s15010-008-8169-x
4. Eke N (2000) Fournier's gangrene: a review of 1726 cases. The British journal of surgery 87:718-728.DOI: 10.1046/j.1365-2168.2000.01497.x
5. Ekingen G, Isken T, Agir H, Oncel S, Günlemez A (2008) Fournier's gangrene in childhood: a report of 3 infant patients. Journal of pediatric surgery 43:e39–e42. DOI: 10.1016/j.jpedsurg.2008.09.014
6. Engels L, Jakob L, Sattler E (2020) Fournier-Gangrän [Fournier gangrene]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandteGebiete 71:10-13. DOI: 10.1007/s00105-020-04624-0
7. Itaimi A, Triki W, Abbassi I, Ayed K, Baraket O, Bouchoucha S (2022) Fournier's gangrene: validation of the severity index. La Tunisiemedicale 100:122–126.
8. Kostovski O, Spasovska O, Trajkovski G, Antovic S, Kostovska I, Tosheska-Trajkovska K, Kuzmanovska B, Pejkova S, Jankulovski N (2021) Challenging Treatment of a Female Patient with Extensive Fournier's Gangrene - Case Report. Prague Med Rep. 122:39-44. DOI: 10.14712/23362936.2021.5
9. Levenson RB, Singh AK, Novelline RA (2008) Fournier gangrene: role of imaging. Radiographics: a review. Radiological Society of North America Inc 28:519-528. DOI: 10.1148/rg.282075048
10. Moon JY, Lee MR, Kim JH, Ha GW (2021) Fournier Gangrene in a Patient With Type 2 Diabetes Mellitus Treated With Dapagliflozin: A Case Report. Ann Coloproctol 37:S48-S50. DOI: 10.3393/ac.2020.06.22
11. Muhammad P, Sulmiati L, Farid M, Elanda P, Robert C, Muhammad F (2020) Fournier's gangrene in a two-month-old infant, Journal of Pediatric Surgery Case Reports, Volume 57,2020,101447, ISSN 2213-5766,DOI: 10.1016/j.epsc.2020.101447.
12. Prasan K (2012) Fournier’s Gangrene: Report of two cases. Case report in emergency medicine. 18, 121-127. DOI: 10.1155/201298415.
13. Sarani B, Strong M, Pascual J, Schwab CW (2009) Necrotizing fasciitis: current concepts and review of the literature. Journal of the American College of Surgeons, 208(2:279–288. DOI: 10.1016/j.jamcollsurg.2008.10.032
14. Serrano A, Bueno I, Martínez C, Gonzále E, Jiménez S (2022) Fournier's Gangrene under Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Gynecological Patients. Int J Environ Res Public Health 19:6261. DOI: 10.3390/ijerph19106261
15. Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K (2006) Fournier's gangrene, and its emergency management. Postgrad Med J 516-9. DOI: 10.1136/pgmj.2005.042069
16. Sharma A, Khanna S, Singh I (2021) Medicinal plants and their components for wound healing applications. Future Journal of Pharmaceutical Sciences 7:2-13.
17. Gupta S, Shareen S, Gupta R, Thakur S (2018) Pharmacological and Phytochemical Updates on Pothosscandens L. Pharmacogn Commn 8:138-145.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to cite

Jangra, S., Bhyan, B., KA, S., Rani, S., Singh, R., & Tare, H. (2023). Genital gangrene in a patient with type II diabetes mellitus, treated with dapagliflozin: a case report. Multidisciplinary Science Journal, 5(1), 2023009. https://doi.org/10.31893/multiscience.2023009

[1] Auerbach J, Bornstein K, Ramzy M, Cabrera J, Montrief T, Long B (2020) Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments, and Current Perspectives. Open access emergency medicine: OAEM 12:353-364. DOI: 10.2147/OAEM.S238699

[2] Czymek R, Frank P, Limmer S, Schmidt A, Jungbluth T, Roblick U, Bürk C, Bruch HP, Kujath P (2010) Fournier's gangrene: is the female gender a risk factor? Langenbeck's archives of surgery 395:173-180. DOI: 10.1007/s00423-008-0461-9

[3] Czymek R, Hildebrand P, Kleemann M, Roblick U, Hoffmann M, Jungbluth T, Bürk C, Bruch HP, Kujath P (2009) New insights into the epidemiology and etiology of Fournier's gangrene: a review of 33 patients. Infection, 37:306-312. DOI: 10.1007/s15010-008-8169-x

[4] Eke N (2000) Fournier's gangrene: a review of 1726 cases. The British journal of surgery 87:718-728.DOI: 10.1046/j.1365-2168.2000.01497.x

[5] Ekingen G, Isken T, Agir H, Oncel S, Günlemez A (2008) Fournier's gangrene in childhood: a report of 3 infant patients. Journal of pediatric surgery 43:e39–e42. DOI: 10.1016/j.jpedsurg.2008.09.014

[6] Engels L, Jakob L, Sattler E (2020) Fournier-Gangrän [Fournier gangrene]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandteGebiete 71:10-13. DOI: 10.1007/s00105-020-04624-0

[7] Itaimi A, Triki W, Abbassi I, Ayed K, Baraket O, Bouchoucha S (2022) Fournier's gangrene: validation of the severity index. La Tunisiemedicale 100:122–126.

[8] Kostovski O, Spasovska O, Trajkovski G, Antovic S, Kostovska I, Tosheska-Trajkovska K, Kuzmanovska B, Pejkova S, Jankulovski N (2021) Challenging Treatment of a Female Patient with Extensive Fournier's Gangrene - Case Report. Prague Med Rep. 122:39-44. DOI: 10.14712/23362936.2021.5

[9] Levenson RB, Singh AK, Novelline RA (2008) Fournier gangrene: role of imaging. Radiographics: a review. Radiological Society of North America Inc 28:519-528. DOI: 10.1148/rg.282075048

[10] Moon JY, Lee MR, Kim JH, Ha GW (2021) Fournier Gangrene in a Patient With Type 2 Diabetes Mellitus Treated With Dapagliflozin: A Case Report. Ann Coloproctol 37:S48-S50. DOI: 10.3393/ac.2020.06.22

[11] Muhammad P, Sulmiati L, Farid M, Elanda P, Robert C, Muhammad F (2020) Fournier's gangrene in a two-month-old infant, Journal of Pediatric Surgery Case Reports, Volume 57,2020,101447, ISSN 2213-5766,DOI: 10.1016/j.epsc.2020.101447.

[12] Prasan K (2012) Fournier’s Gangrene: Report of two cases. Case report in emergency medicine. 18, 121-127. DOI: 10.1155/201298415.

[13] Sarani B, Strong M, Pascual J, Schwab CW (2009) Necrotizing fasciitis: current concepts and review of the literature. Journal of the American College of Surgeons, 208(2:279–288. DOI: 10.1016/j.jamcollsurg.2008.10.032

[14] Serrano A, Bueno I, Martínez C, Gonzále E, Jiménez S (2022) Fournier's Gangrene under Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Gynecological Patients. Int J Environ Res Public Health 19:6261. DOI: 10.3390/ijerph19106261

[15] Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K (2006) Fournier's gangrene, and its emergency management. Postgrad Med J 516-9. DOI: 10.1136/pgmj.2005.042069

[16] Sharma A, Khanna S, Singh I (2021) Medicinal plants and their components for wound healing applications. Future Journal of Pharmaceutical Sciences 7:2-13.

[17] Gupta S, Shareen S, Gupta R, Thakur S (2018) Pharmacological and Phytochemical Updates on Pothosscandens L. Pharmacogn Commn 8:138-145.

Abstract

References

How to cite