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Infections from Injections of Contaminated Steroids

June 25, 2013

Infections from Injections of Contaminated Steroids

  1. Richard T. Ellison III, MDAU075

MRI screening identified unrecognized spinal and paraspinal infections in patients who had received injections of contaminated steroids.

  1. Richard T. Ellison III, MDAU075

During the last year, more than 740 patients have developed fungal meningitis, spinal or paraspinal infections, or other complications following injections of contaminated methylprednisolone prepared by one Massachusetts compounding pharmacy. Fungal meningitis was seen early in the outbreak; spinal and paraspinal infections have occurred later, sometimes many months after the implicated injections. Because early recognition and treatment should be beneficial, researchers in Michigan developed a magnetic resonance imaging (MRI) screening protocol that was offered to recipients of one lot of contaminated methylprednisolone used at a single pain-treatment center.

Between November 2012 and April 2013, screening spinal MRI studies were performed on 172 patients who had not presented for medical care related to the contaminated injection. Thirty-six patients had abnormal findings suggestive of infection, and 18 had equivocal results. Subsequent work-up identified probable or confirmed Exserohilum infection in 35 patients; all 35 received antifungal therapy, and 24 required surgery. Among 115 patients who received symptom screening at the time of MRI scheduling, 35 (including 22 with infection) noted worsening back or neck pain, radiculopathy, or lower extremity weakness. Thirteen patients with infection, including 7 who required surgery, denied having symptoms.

Comment

As noted by editorialists, the high incidence of spinal and paraspinal infection noted in this study may not be representative of the outbreak as whole, given likely differences in levels of contamination of the steroid preparations, storage conditions, extent of exposure, and host factors. However, the observation that many of the infected patients were asymptomatic at the time they were screened indicates that, at a minimum, higher-risk recipients of contaminated steroids should be considered for screening MRI studies even if they are asymptomatic.

  • Disclosures for Richard T. Ellison III, MD at time of publication Grant / research support NIH-NIAID

Citation(s):

Reader Comments (1)

krishnakumar sukumaran MD Physician, Nephrology, SUT Royal

Not very supportive

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