Fournier gangrene in a patient with corticotrophinoma and diabetes treated with sodium–glucose cotransporter 2 inhibitor

Hypercortisolism induces immunosuppression, and infections represent the second leading cause of death among patients with Cushing syndrome. We report the case of an adult man with a silent corticotroph pituitary adenoma that evolved into a functioning adrenocorticotropic hormone-secreting tumor. The patient had diabetes mellitus and was treated with dapagliflozin. Prior to transsphenoidal adenomectomy, he developed Fournier gangrene, a necrotizing fasciitis of the perineal and genital regions. Infectious management included debridement, antibiotics, and hyperbaric oxygen therapy. After adequate control of the infection, pituitary surgery was performed, resulting in hypercortisolism remission. Although Cushing syndrome is well known to predispose patients to infections, the association between endogenous hypercortisolism and Fournier gangrene has been scarcely described in the literature. The present case highlights the risk of this severe soft tissue infection in patients with Cushing syndrome. Dapagliflozin and other sodium–glucose cotransporter 2 inhibitors have been investigated as potential contributors to Fournier gangrene in patients with diabetes mellitus, prompting a discussion about the safety of prescribing these agents in the setting of hypercortisolism.