Endocrine Abstracts

Introduction: Dapagliflozin is sodium-glucose co-transporter receptor 2 (SGLT2) inhibitor that is recently discovered an oral antidiabetic (OAD) agent that improves glycemic control by increasing the renal excretion of glucose. Vulvovaginal candidiasis (VVC) is the infection of the vaginal vestibuler area. We present a case of VVC accompanied by use of dapagliflozin.

Case: A-48-year-old woman who had T2DM since 8 years was admitted to the endocrinology clinic. Her past medical history was remarkable for atopic dermatitis. Her body mass index was 33.7 kg/m². She had been using metformin and sulfonylurea. Her initial laboratory results were; fasting plasma glucose: 131 mg/dl, hemoglobin A1c: 7.8%. Dapagliflozin 10 mg daily therapy added to her therapy. On the 12th day of dapagliflozin therapy she noted vulvovaginal pruritus. Three days later she complained the severity of symptoms. Physical examination revealed wide erythema on vulvar, vaginal and perineal regions of genitourinary area. Positive vaginal culture for Candida albicans was detected. She was diagnosed with VVC. The treatment of VVC was made through topical clotrimazole. Three days later the clinical manifestations become worsened and dapagliflozin was discontinued. Signs and symptoms of VV were regressed two days later.

Summary: Vulvovaginitis is a frequently encountered acute and recurrent complication of diabetes mellitus; tend to be worsened by poor glycemic control. Appropriate diagnosis and management is essential to confirm optimal genital and metabolic health. We consider that this case will be mostly useful among atopic patients who have potential risk for VVC and drug withdrawal may be considered in such of these patients.