Extensive empagliflozin-associated Fournier’s gangrene with complete functional recovery – A case report

A 35-year-old diabetic male developed extensive Fournier’s gangrene after 8 months of empagliflozin therapy, representing, to our knowledge, one of the youngest documented cases. The infection progressed rapidly with 80% scrotal involvement within 72 h, necessitating four surgical debridements. Through aggressive staged debridement, negative pressure therapy, and fluorescence-guided tissue assessment, bilateral testicular preservation was achieved despite severe tissue destruction. Complete functional recovery with normal sexual function and no psychological sequelae was documented at 6 months using validated tools. This case demonstrates that extensive sodium-glucose cotransporter-2 inhibitor-associated Fournier’s gangrene can achieve excellent outcomes with early aggressive intervention, challenging existing prognostic assumptions and providing valuable insights for clinical management.