Table 3 Drug use, drug initiation, presenting signs and symptoms, complications, management, and follow-up results

Jahir et al. [14]

Empagliflozin

NA

Severe pain, redness, and swelling in the right upper thigh and perineum for the past week. A review of the system was remarkable for a severely tender, indurated, erythematous, possible abscess-like lesion in the right upper thigh and pelvis, which was associated with fever and chills. Patient appeared toxic, with significantly tender, warm, erythematous, indurated crepitation on the perineum and area on the medial aspect of the right thigh with mild malodorous vaginal discharge

Septic

1. Intravenous fluid according to sepsis protocol (30 ml/kg)

2. Broadspectrum antibiotics, including vancomycin, meropenem, and clindamycin

3. Emergency exploration surgery with washout and application of a vacuum dressing in the right thigh

4. Empagliflozin was discontinued and started on a basal-bolus insulin regimen

In 3 days the total WBC count downtrend from 11.3

Vargo et al. [15]

Dapaglifozin, metformin

NA

Enlarging, painful left hemiscrotum over the previous few years. Physical examination was consistent with a large left hydrocele and scrotal ultrasound confirmed the diagnosis

None

1. Hydrolectomy

2. SGLT2 inhibitors were stopped

The patient was discharged from the hospital on postoperative day nine on intravenous antibiotics, and he ultimately underwent complex scrotoplasty two months after discharge

Kumar &Costello [16]

Empaglifozin, Metformin

14 months

Scrotal Pain and Swelling. Grossly swollen and indurated scrotum with tender spermatic cord, epididymis, and testicles. Bilateral inguinal lymphadenopathy

N/A

1. Discontinued empaglifozin and smoking

2. Basal-bolus insulin regimen

3. Exploration, washout, and application of a vacuum dressing

4. Sin grafting to his perineum

5. Initial antibiotic management included intravenous amoxicillin, gentamicin, and vancomycin which was changed to intravenous meropenem for a total 14-day course

Discharged after day 15 on oral antibiotics

Onder et al. [17]

Dapaglifozin, premixed insulin twice a day, vildagliptin, and metformin

6 Months

Scrotal pain, swelling, and redness that had progressed over a period of 3 days

N/A

1. Discontinued dapagliflozin,

2. Started basal-bolus insulin regimen, debridement

3. Empirical intravenous antibiotics (ceftriaxone 1 g, twice a day, and metronidazole 500 mg, three times a day),

4. Plastic surgery for reconstruction of defective tissues and a fasciocutaneous flap to cover the perianal scrotal and penile regions

Discharged after 4 weeks course of intravenous antibiotics

Elshimy et al. [18]

Empagliflozin, glipizide, metformin, linagliptin

10 days

Perineal examination revealed a grossly swollen and indurated right scrotum with tender spermatic cord, epididymis, and testicles

Peripheral neuropathy, Hashimoto’s hypothyroidism

Stopped all oral medications in the hospital and two surgical interventions with hyperbaric oxygen therapy

N/A

Elbeddini et al. [19]

Canafligozin

Six years

Rectal pain. The patient presented to the ED for the third time 2 days after his previous visit with abdominal pain rated 8/10 and significant nausea. He reported explosive diarrhea which persisted throughout the first 5 days of his admission

Horseshoe abscess and posterior communication of bilateral ischiorectal fossa

1. Aggressive debridement

2. Intravenous antibiotic

3. Oral antibiotics,

4. Discontinued canagliflozin

5. Home medications: metformin, sitagliptin, and insulin glargine

N/A

Elbeddini et al. [20]

Dapagliflozin, glimepiride, and linagliptin

Five years taking dapagliflozin

Patient came to the hospital after a fall in the bathroom, patient didn’t feel pain but just discomfort for a few days. There was an extensive abscess was observed in the perianal area with 5 cm of necrotic tissue and foul-smelling discharge

N/A

1. Intravenous antibiotic using vancomycin, intravenous piperacillin–tazobactam, and intravenous clindamycin

2. Patient got debridement, rigid sigmoidoscopy, and perianal ring block

3. Insulin glargine 10 U with breakfast then insulin aspart three times daily on a low–moderate sliding scale

4. Dapagliflozin was discontinued

After 14 days of hospitalization, the patient was discharged with controlled blood glucose under insulin administration and a clean and odorless wound

Kasbawala & Stamatiades [21]

Canaglifozin, metformin, and sitagliptin

One month

After 1 month she complained of pain in the left gluteal region associated with dysuria and therapy with trimethoprim/sulfamethoxazole for a presumed urinary tract infection was initiated

Diabetic Ketoacidosis

1. Fluid resuscitation with initial bolus normal saline 0.9%

2. Intravenous empirically of antibiotic

3. IV clindamycin, and vancomycin, debridement

4. Incision and drainage

5. DKA was treated with only subcutaneous insulin

6. Patient using insulin glargine 18 U and discontinued canagliflozin and sitagliptin-metformin

On 28 days the patient was DKA resolved and medically stable condition with a urinary catheter, vacuum dressing, and colonostomy in place at a short-term rehabilitation facility

Ellegardz and Prytz [22]

Dapaglifozin, insulin

1.5 years using dapaglifozin

Three days of fever and increased swelling and pain in the gluteal region. An abscess, the size of a tennis ball, 5 cm from the anus on the left side of the gluteal region. It was indurated, inflamed, and warm with pus discharge from a minor opening. The right side of the gluteal region was unaffected

NA

1. Intravenous fluid

2. Broadspectrum antibiotics (4 g piperacillin with 0.5 g tazobactam)

3. Intravenous cortisone were rapidly initiated

4. The patient underwent surgical exploration three times

5. Dapaglifozin was discontinued permanently

The patient was discharged on day 18. Two months later, the healing process was still ongoing, and the wound was tended to by home health care daily. Five months later, the wounds were fully healed with new skin covering the area

Vadi and Ismail [23]

Empaglifozin, Vildagliptin

2 years

Testicular swelling and localized pain for 10 days. There was discoloration and edema of the external genitalia

NA

1. Intravenous antibiotics (meropenem),

2. Intravenous fluids, short-acting insulin,

3. Surgical debridement

4. Empagliflozin and vildagliptin were discontinued

The wound had healed well with blood glucose levels under control

Nagano et al. [24]

Empaglifozin, glibenclamide, sitagliptine

5 months

Pain and swelling in the perineum. Skin redness, induration, swelling, and tenderness were observed in the perineum, scrotum, and left inguinal region

None

1. Surgical incision, debridement

2. Postoperatively, the medications for T2DM were discontinued

3. Drainage. Intravenous antibiotics (meropenem and clindamycin which was changed to vancomycin after MRSA was cultured)

4. Sitagliptin restarted 9 days after surgery

5. Metformin started 21 days after surgery

6. Insulin initiated according to a sliding scale

The patient’s wounds healed gradually. He was discharged from the hospital 41 days after surgery and continued his therapy for T2DM

Rodler et al. [25]

Dapaglifozin, Metformin, Sitagliptin

4 years

Fever (1 week), swelling, and pain in groin and testicles with pus discharge. Swelling in the right groin, intense smell

delirium and derailed diabetes mellitus

1. Removal of necrotic tissue and further debridement procedures

2. Intravenous antimicrobials (gentamicin and piperacillin–tazobactam) started in ED was changed to linezolid, meropenem, and nystatin;

3. Linezolid stopped and meropenem and nystatin changed to fluconazole)

4. Dapagliflozin discontinued

5. Basal-bolus insulin from admission to day 19

6. Metformin and sitagliptin restarted on day 23 of admission

NA

Cecilia-Chi & Lim-Tio [26]

Dapagliflozin

3 weeks

5 days of increasing scrotal pain and swelling. Scrotal swelling, tenderness, and erythema tracking down the perineum

NA

1. Surgical debridement and broadspectrum antibiotics

2. Dapagliflozin was ceased and basal-bolus insulin commenced

Discharged after 51 hospital days

Omer et al. [27]

Dapaglifozine, Metformin, Glicazide, insulin, exanetide, and pioglitazone

2 years

Painful and red between his scrotum and anus. High-grade fever and fatigue

Septic

1. Intravenous flucloxacillin, ciprofloxacin and metronidazole

2. Debridement

3. Dapagliflozin was withheld and not restarted

NA