What may predispose a patient to the development of Fournier gangrene?

Updated: Jun 03, 2021
  • Author: Vernon M Pais, Jr, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Any condition that depresses cellular immunity may predispose a patient to the development of Fournier gangrene. Examples include the following:

  • Diabetes mellitus (present in as many as 60% of cases) [30, 26]
  • Morbid obesity
  • Alcoholism
  • Cirrhosis
  • Extremes of age
  • Vascular disease of the pelvis
  • Malignancy (eg, acute leukemia) [31, 32]
  • Systemic lupus erythematosus [33]
  • Crohn disease
  • HIV infection [34] ref34}
  • Malnutrition
  • Iatrogenic immunosuppression (eg, from long-term corticosteroid therapy or chemotherapy [35] )

The US Food and Drug Administration (FDA) has noted an increased risk for Fournier gangrene in patients with type 2 diabetes mellitus treated with sodium-glucose cotransporter-2 (SGLT2) inhibitors.  SGLT2 inhibitors were first approved in 2013, and by 2019, 55 cases of Fournier gangrene had been reported in patients receiving these agents. By comparison, only 19 cases of Fournier gangrene have been reported over 35 years in patients taking other diabetes drugs. [36]

Details of Fournier gangrene cases associated with SGLT2 inhibitors included the following [36] :

  • Patients ranged in age from 33 to 87 years; 39 were men, 16 were women.
  • Onset of Fournier gangrene after initiation of SGLT2 inhibitors ranged from 5 days to 49 months.
  • Complications included diabetic ketoacidosis, sepsis, and kidney injury.
  • Eight patients underwent fecal diversion surgery, two patients required amputation of a lower extremity due to  necrotizing fasciitis, and three patients died.

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