Spinal Steroid Injection Scare

By now, anyone who reads or watches the news has heard of the outbreak of fungal meningitis caused by injections of contaminated lots of the steroid methylprednisolone acetate given for neck or back pain. The medicine was prepared and shipped by New England Compounding Center (NECC) in Framingham, MA. First, I want to reassure all of our patients that Riverchase Dermatology does not perform spinal injections, does not inject methylprednisolone, and does not order any products from NECC.

The tainted lots were distributed to 76 pain clinics in 23 states. It is estimated that about 14,000 patients have received epidural injections with the material for neck and back pain. The needle is passed through the skin in the space between the vertebral bones, and the medicine is injected around the lining of the spinal cord. So far, as of this writing, 409 cases of meningitis and 30 deaths have been reported in 19 states by the Centers for Disease Control & Prevention (CDC). There have also been 10 cases of peripheral joint infections. Unfortunately, these numbers appear to be rising on a daily basis. Most of the cases and deaths have occurred in Tennessee. In Florida, 1038 patients received injections from NECC, and health officials have reported 23 cases and 3 deaths.

The predominant fungal organism isolated from cultures of spinal fluid is Exserohilum. The CDC has also found this fungus in sealed vials of preservative-free methylprednisolone produced by NECC. At first, the CDC mandated a recall of the three contaminated lots. Subsequently, NECC closed down its operation, voluntarily surrendered its license, and recalled all of its many other products in addition to methylprednisolone. The FDA commissioner Dr. Margaret Hamberg will testify before Congress in November as the investigation into the meningitis outbreak continues.

Meningitis may be slow to develop and is difficult to diagnose, but there are oral and injectable anti-fungal drugs available to treat it. Once infected, the disease is not transmissible to others.

Kenalog 40 mg/cc vials used for intramuscular injection at Riverchase Dermatology.
Back of vial shows lot number and expiration date.

In our Dermatology offices, we may inject the steroid triamcinolone into the dermis of the skin for inflammatory diseases such as cystic acne and psoriasis. These are called intralesional injections. We may also inject a higher concentration of triamcinolone into the muscle of the buttock for systemic effect to treat severe atopic eczema or poison ivy dermatitis, for example. These injections are given for inflammation and itching, not for pain. We purchase triamcinolone acetonide 10 mg/cc or 40 mg/cc as the brand Kenalog which is manufactured by Bristol-Myers Squibb and distributed by Henry Schein Medical. We want to assure you that our patients’ safety is our primary concern and that there have been no problems associated with Kenalog injections.

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