Fournier’s Gangrene in an HIV-Positive Patient Using a Sodium-Glucose Cotransporter-2 Inhibitor: A Case Report

Fournier’s gangrene (FG) is a rapidly progressive necrotizing fasciitis affecting the perineal, genital, or perianal regions. It is a rare but potentially life-threatening condition that predominantly affects immunocompromised individuals, including those infected with the human immunodeficiency virus (HIV). Recent findings have highlighted the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) for patients with diabetes mellitus, such as prevention and treatment of cardiovascular disease, heart failure, and kidney disease. This supports both the expansion of their indications and the development of drug combinations with first-line medications. However, the increased risk of genitourinary infections is a well-known side effect of SGLT2i. This report describes the case of a 62-year-old man with well-controlled HIV infection, hypertension, and diabetes mellitus, who was using an SGLT2i and presented with FG. The patient underwent prompt surgical debridement, antibiotic therapy, and discontinued the SGLT2i, followed by wound reconstruction using a local transposition flap. This resulted in a successful outcome, with no further wounds observed for 3 months. This case underscores the potential synergistic risk factors of SGLT2i use and HIV infection in the development of FG and highlights the critical importance of prompt surgical intervention.