EXPRESS: Candida albicans urinary tract infection in a cat treated with velagliflozin

Case Summary: A 15-year-old male neutered Domestic Shorthair cat presented with anuria due to urethral obstruction. The cat had a history of several urinary and systemic comorbidities at the time of presentation. Velagliflozin therapy had been started recently following a new diagnosis of diabetes mellitus. A mixed urinary tract infection caused by Escherichia coli and Candida albicans was diagnosed. The cat was initially managed with urinary catheterisation, antibiotics and antifungals, showing a favourable response. However, recurrent urinary obstruction occurred, requiring multiple urinary catheterisations. Approximately 2 weeks after presentation, urethral rupture was diagnosed using contrast urography. Urethrostomy was declined and the cat was ultimately euthanased. Relevance and Novel Information: The most frequent adverse effect reported in human patients treated with sodium–glucose cotransporter 2 inhibitors is mycotic genitourinary infection, particularly caused by C albicans. Several risk factors have been identified in humans; however, this association has not been previously demonstrated in cats. This is the first report describing a urinary tract infection caused by C albicans in a cat treated with velagliflozin. These findings emphasise the importance of monitoring for this potential adverse effect in cats receiving sodium-glucose cotransporter 2 inhibitors (SGLT2i), particularly in those with comorbidities, and encourage further evaluation of SGLT2i as a putative risk factor for C. albicans urinary tract infections in these patients.