Screening with magnetic resonance imaging identified 21% of patients with a spinal or paraspinal infection resulting from a tainted steroid injection, researchers reported in JAMA.
A multistate outbreak of fungal meningitis that started in the fall of 2012 was linked to vials of methylprednisolone that were contaminated with Exserohilum rostratum at the New England Compounding Center. Besides cases of fungal meningitis, the contaminated vials also were linked to spinal and paraspinal infections.
Researchers from St. Joseph Mercy Hospital in Ann Arbor, Mich., evaluated 172 patients who had received injections from a contaminated lot at a pain treatment facility, but did not experience symptoms or seek medical care for adverse events related to the injection. The patients underwent screening MRI from Aug. 9, 2012, to Nov. 8, 2012.
Thirty-six patients had an abnormal MRI. The MRIs revealed phlegmon in 30 patients, abscesses in 13 patients, spinal osteomyelitis or diskitis in seven patients, and arachnoiditis in six patients. Six patients had severe enhancement and 30 patients had moderate enhancement. The researchers also collected information from 115 patients on new or worsening back or neck pain, radiculopathy or lower-extremity weakness, and 35 of the patients had at least one of these symptoms.
Of the 36 patients with an abnormal MRI, 35 met the CDC’s criteria for probable or confirmed fungal spinal or paraspinal infection. All patients were treated with voriconazole with or without liposomal amphotericin B. Twenty-four patients also required surgical debridement.
“Our findings support obtaining contrast-enhanced MRI of the injection site in patients with persistent back pain even when their pain disorder has not worsened,” the researchers wrote. “Such patients have been found to have abscesses, phlegmons and spinal osteomyelitis or diskitis with MRI. MRI may detect infection earlier in some patients, leading to more efficacious medical and surgical treatment and improved outcomes.”
Disclosure: The researchers report financial relationships with Cubist Pharmaceuticals, Pfizer, Gilead, Merck and Genentech.