Abstract Fournier’s gangrene is a life-threatening necrotizing fasciitis of the genitoperineal region with 20%–40% mortality despite aggressive treatment. While SGLT2 inhibitors are associated with this condition, extensive scrotal involvement developing rapidly remains uncommonly reported. We present a 52-year-old male with longstanding type 2 diabetes who developed fulminant Fournier’s gangrene 6 weeks after initiating canagliflozin. His severe diabetic neuropathy masked early symptoms, causing delayed presentation and catastrophic tissue loss requiring complete scrotal excision of approximately 450 square centimeters. This case highlights the heightened vulnerability of neuropathic patients to SGLT2 inhibitor-associated necrotizing fasciitis. Although absolute risk remains extremely low, clinicians should recognize neuropathic patients as high-risk and emphasize daily perineal visual inspection when prescribing SGLT2 inhibitors. Appropriate patient selection, comprehensive education, and vigilant monitoring are essential to minimize this rare complication while preserving substantial cardiovascular and renal benefits.
Garg et al. (Wed,) studied this question.