Abstract 18489: Double Edged Sword: SGLT-2 Inhibitors in the Immunosuppressed Heart Failure Patient

Abstract

Introduction: SGLT-2 inhibitors are often prescribed for patients with heart failure, as a part of Goal Directed Medical Therapy. There is a known risk of genitourinary tract infections with utilizing this medication class. We present a case of a patient on chronic immunosuppression therapy on Dapagliflozin who developed a prostate abscess. Case Description: 70-year-old male with history of cardiac sarcoidosis on prednisone and mycophenolate mofetil, non-ischemic cardiomyopathy, and atrial fibrillation who initially presented with suprapubic pain and urinary urgency for two weeks. Urinalysis was positive for glucose greater than 1,000 and urine culture positive for Klebsiella pneumoniae. CT imaging revealed a prostate abscess measuring 4.5 x 4.4 x 5.7cm. Patient underwent CT guided drainage of the prostate abscess with thick, purulent drainage that cultured positive for Klebsiella pneumonia. He was initially started on an 8-day course of Ceftriaxone but transitioned to Trimethoprim-Sulfamethoxazole for 6-weeks at discharge. He was previously prescribed Empagliflozin for heart failure, however, this was discontinued due to expense and was switched to Dapagliflozin four months prior to presentation. Discussion: SGLT-2 inhibitors are commonly prescribed in heart failure patients. We encourage special consideration in patients at increased risk of infection, prior to starting SGLT-2 inhibitors as they may have more complicated manifestations of side effects. In this case, the patient underwent procedural interventions and required long term antibiotic therapy as a consequence of SGLT-2 inhibitor use. Conclusion: Patients who are chronically immunosuppressed are at increased risk for infections, including genitourinary, compared to the general population. While trying to optimize patient's cardiomyopathy, it is imperative to consider their risk for developing complications when initiating SGLT-2 inhibitors in immunocompromised patients.