Dapagliflozin-Induced Vulvovaginitis in an Atopic Patient with Type 2 Diabetes Mellitus

ABSTRACT

Dapagliflozin, an oral anti-diabetic agent, is a recently discovered sodium-glucose co-transporter receptor-2 inhibitor, which improves glycemic control by facilitating the renal excretion of glucose. Urinary and genital tract infections are common in type-2 diabetes mellitus. Vulvovaginal candidiasis is an infection of the vaginal vestibular area. We present a case of vulvovaginal candidiasis associated with the use of dapagliflozin. A 48-years-old female patient having type-2 diabetes mellitus for the past eight years was admitted to our outpatient clinic. Her medical history was remarkable for atopic dermatitis. She was using metformin and sulfonylurea. Her hemoglobin A1c was 7.8%. A daily dose of 10 mg dapagliflozin was added to her treatment. On the 12th day of dapagliflozin therapy, she noted vulvovaginal pruritus, which was reported three days later, after the symptoms worsened. Physical examination revealed widespread erythema on vulvar, vaginal, and perineal regions of the genitourinary area. The vaginal culture was positive for Candida albicans. Thus, the patient was diagnosed with vulvovaginal candidiasis. The symptoms of vulvovaginal candidiasis were managed through the topical application of clotrimazole. Three days later, the clinical manifestations worsened, and dapagliflozin was discontinued. This led to the regression in signs and symptoms of vulvovaginal candidiasis. Hence, an appropriate diagnosis and management of vulvovaginal candidiasis were essential to provide optimal genital and metabolic health. We believe that this case will be highly relevant among atopic patients at potential risk of vulvovaginal candidiasis and recommend that a drug withdrawal may be considered in such patients.