Dapagliflozin induced balanitis in a patient with type two diabetes mellitus: a case report

Abstract

Dapagliflozin, an SGLT2 inhibitor used to control high blood sugar in patients having type II diabetes mellitus by blocking the SGLT2, present in the early proximal tubules of the kidney, thereby preventing glucose reabsorption into the blood and promoting excess glucose removal through urine causing glucosuria. Increased glucose concentration in urine in genitourinary tract creates a hostile environment for bacterial and fungal growth. Balanitis, condition where the glans penis is inflamed characterized by pain, redness, and swelling. This condition affects the male genitalia, most common causes being poor hygiene, accumulation of smegma beneath the foreskin, diabetes, and the use of SGLT2 inhibitors in diabetic patients. This is a case of 75-year-old male patient with the history with type 2 diabetes, hypertension, and triple vessel coronary artery disease, underwent successful off-pump CABG, following the surgery dapagliflozin 5 mg OD was advised for diabetes management. After 3 weeks of dapagliflozin 5 mg administration patient experienced frequent urination, swelling of the glans penis, painful micturition, and itching that persisted for more than a week. The urinalysis showed the presence of glucose in the urine despite having nearly normal blood sugar levels confirmed the presence of balanitis which was dapagliflozin induced. Dapagliflozin was immediately discontinued, and symptoms subsided. Naranjo scale was used for causality assessment, which produced a score of 7, indicating a probable adverse drug effect. This case highlights the necessity of early detection of symptoms, pre-treatment guidance, and rapidly stopping the medication to prevent complications in patients undergoing SGLT2 inhibitor therapy.