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Sodium–glucose cotransporter 2 inhibitor-associated severe epididymo-orchitis
  1. Rahul Mishra1,
  2. Ghada Elshimy2,
  3. Lakshmi Kannan3 and
  4. Rishi Raj4,5
  1. 1Research Fellow, Hematology and Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  2. 2Endocrinology, Augusta University Medical College of Georgia, Augusta, Georgia, USA
  3. 3Nephrology, Pikeville Medical Center, Pikeville, Kentucky, USA
  4. 4Endocrinology, Diabetes, and Metabolism, Pikeville Medical Center, Pikeville, Kentucky, USA
  5. 5University of Pikeville- Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
  1. Correspondence to Dr Rishi Raj; rishiraj91215{at}


A man in his late 50s, with uncontrolled type 2 diabetes mellitus (T2DM) and morbid obesity, presented to the hospital with complicated epididymo-orchitis. The onset of symptoms (scrotal pain, erythema and swelling) occurred after the use of empagliflozin, a sodium–glucose cotransporter 2 (SGLT2) inhibitor, for 2 months. His baseline antidiabetic medications were insulin, glipizide and metformin. Initially, he had failed treatment of epididymo-orchitis with oral levofloxacin for 3 weeks, followed by 2 weeks of doxycycline therapy. At the presentation to the hospital, an ultrasound of the scrotum revealed scrotal and right testicular abscess. The patient underwent right inguinal orchiectomy. Postoperatively, pus culture was positive for Enterococcus faecalis and Candida glabrata, and hence, he was treated with oral antibiotics including high-dose antifungal medications. Adequate wound care and regular follow-up demonstrated resolution of infection. This case highlights the risk of severe urogenital infection associated with the use of SGLT2 inhibitors in the setting of uncontrolled T2DM.

  • Endocrine system
  • Infections
  • Urinary and genital tract disorders
  • Diabetes
  • Urinary tract infections

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  • Contributors RM, GE, LK and RR were directly involved in the conceptualisation of the study, data collection, literature review,and writing of the manuscript. All authors reviewed and finalised the manuscript in its current form.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.