Background: The Sodium glucose co-transporter 2(SGLT2) inhibitors are the newest class of oral hypoglycemic agents  with a novel mechanism of action which makes these medications an intriguing option for patients throughout the natural history of type 2 diabetes and as a possible adjunct therapy for type 1 diabetes with close supervision. The FDA Adverse Event Reporting System (FEARS) database identified 19 cases of urosepsis with SGLT2 inhibitors, four of them required ICU admissions but none with empagliflozin.  

This patient is a 76-year-old male, long standing type 2 DM, well controlled on metformin. Background history of hypertension, obesity, Dyslipidemia, coronary artery disease, Severe LV dysfunction. With all of that in mind, he was started on empagliflozin. One month later he was admitted to the ICU with life-threatening septic shock secondary to urinary tract infection required high dose of inotrope. 

This case illustrates the temporal association between the SGLT2 inhibitor (empagliflozin) and serious UTIs.