HighlightsInfections due to XDR Pseudomonas are at increased risk of complications and death.CNS involvement may be due to poor CNS penetration of drugs with residual activity.XDR-PA meningitis ensued during treatment with colistin for pneumonia and bacteremia.CNS involvement by XDR-PA was timely suspected and quickly documented on CSF.High dose C-T and Fosfomycin provided rapid control of meningitis.
Background
Undesired intrathecal injections represent an important subset of medical errors, albeit rare. Clinical effects depend on the type and concentration of drug(s) injected. Here we report on the case of a healthy woman with persistent low back pain, treated with a paravertebral injection of lidocaine, thiocolchicoside, and l-acetylcarnitine at an orthopedic practice.
Case report
A 42-year-old Caucasian woman, with no relevant past medical history, received a lumbar paravertebral injection of lidocaine, thiocolchicoside, and l-acetylcarnitine for persistent low back pain. Approximately 30 minutes after injection, she experienced quick neurological worsening. Upon arrival at the Emergency Department, she was comatose, with fixed bilateral mydriasis, trismus, and mixed acidosis; seizures ensued in the first hours; slow progressive amelioration was observed by day 6; retrograde amnesia was the only clinical relevant remaining symptom by 6 months.
Conclusions
To our knowledge, this is the first reported case of inadvertent intrathecal thiocolchicoside injection in an adult patient, as well as the first in the neurosurgical literature. Our experience suggests that injection therapy for low back pain should be administered in adequate settings, where possible complications may be promptly treated.
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