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Be Vigilant About Perianal Pain

  • Michael Balkin
    Correspondence
    Requests for reprints should be addressed to Michael Balkin, MD, Division of Endocrinology, Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554.
    Affiliations
    Division of Endocrinology, Department of Medicine, Nassau University Medical Center, East Meadow, NY
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Published:December 16, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.10.011
      To the Editor:
      The Diagnostic Dilemma reported by Kawahigashi et al is particularly timely in view of the increasing use of sodium glucose cotransporter 2 (SGLT2) inhibitors for diabetes and heart failure.
      • Kawahigashi T
      • Kawabe T
      • Iijima H
      • et al.
      Beware of perianal pain: Fournier gangrene.
      ,
      • Chiang CE
      • Wang KL
      • Cheng HM
      • Sung SH
      • Chao TF
      Second revolution in cardiovascular prevention.
      Many of us are learning for the first time about Fournier gangrene and its relationship to SGLT2 inhibitors.
      • Hu Y
      • Bai Z
      • Tang Y
      • et al.
      Fournier gangrene associated with sodium-glucose cotransporter-2 inhibitors: a pharmacovigilance study with data from the U.S. FDA adverse event reporting system.
      We have now become more vigilant about questioning and evaluating our diabetic patients for perianal symptoms. Although there would appear to be no relationship to medication usage and the development of an abscess in what the authors described as a long-standing mass, given the evolving knowledge of Fournier gangrene we must be explicitly informed as to whether the patient was exposed to an SGLT2 inhibitor.

      References

        • Kawahigashi T
        • Kawabe T
        • Iijima H
        • et al.
        Beware of perianal pain: Fournier gangrene.
        Am J Med. 2020; 133: 924-925
        • Chiang CE
        • Wang KL
        • Cheng HM
        • Sung SH
        • Chao TF
        Second revolution in cardiovascular prevention.
        J Chin Med Assoc. 2020; 83: 327-336
        • Hu Y
        • Bai Z
        • Tang Y
        • et al.
        Fournier gangrene associated with sodium-glucose cotransporter-2 inhibitors: a pharmacovigilance study with data from the U.S. FDA adverse event reporting system.
        J Diabetes Res. 2020; 20203695101

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      • The Reply
        The American Journal of MedicineVol. 134Issue 3
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          We thank Michael Balkin for his interest in our article.1 He made an important point about our case: The use of sodium glucose cotransporter-2 (SGLT2) inhibitors may be associated with the development of Fournier gangrene.2 It is worthwhile to mention that diabetes is one of the most common comorbid risk factors for Fournier gangrene and the use of SGLT2 inhibitors for type 2 diabetes mellitus is increasing each year because of the significant cardiovascular benefit of SGLT2 inhibitors in people with type 2 diabetes.
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