Candida albicans urinary tract infection in a cat treated with velagliflozin

Case summary A 15-year-old, male neutered domestic shorthair cat presented with anuria due to urethral obstruction. The cat had a history of several urinary and systemic comorbidities at the time of presentation. Velagliflozin therapy had been started recently after a new diagnosis of diabetes mellitus. A mixed urinary tract infection caused by Escherichia coli and Candida albicans was diagnosed. The cat was initially managed with urinary catheterisation, antibiotics and antifungals, showing a favourable response. However, recurrent urinary obstruction occurred, requiring multiple urinary catheterisations. Approximately 2 weeks after presentation, urethral rupture was diagnosed using contrast urography. Urethrostomy was declined and the cat was ultimately euthanased. Relevance and novel information The most frequent adverse effect reported in human patients treated with sodium–glucose cotransporter 2 inhibitors (SGLT2is) is mycotic genitourinary infection, particularly caused by C albicans. Several risk factors have been identified in humans; however, this association has not been previously demonstrated in cats. This is the first report describing a urinary tract infection caused by C albicans in a cat treated with velagliflozin. These findings emphasise the importance of monitoring for this potential adverse effect in cats receiving SGLT2is, particularly in those with comorbidities, and encourage further evaluation of SGLT2is as a putative risk factor for C albicans urinary tract infections in these patients.