PENICILLIN injections, like any effective drug or procedure, are not completely devoid of occasional unpleasant or dangerous reactions. Injections of penicillin have caused anaphylaxis, urticaria, exfoliative dermatitis, and other evidence of hypersensitiveness.Peripheral nerve damage has resulted from injection into or near the sciatic nerve. To our knowledge, the extraordinary complications presented by the following two cases have not been reported previously.
Report of CasesCase 1.\p=m-\This boy of 15 months was admitted to a hospital in another city on May 29, 1965. The child had been well previously except for a mild diarrhea ten days before. On the day before admission, the child had a fever of 103 F (39.4 C) and was found to have tonsillitis and otitis media in the right ear. At 5 pm, 600,000 units, 2 ml, of a mixture of benzathine penicillin G and procaine penicillin G (Bicillin C-R 600) was injected into the upper outer quadrant of the right buttock, in the precise location generally recommended for such injections when they are given into the buttocks. No blood was ob¬ served in the syringe on negative pressure, but a spurt of blood followed the withdrawal of the needle. Within two or three minutes, an area of blanching surrounded the injected area and rapidly involved the right lower extremity; the left lower extremity quickly showed similar vasomotor reac¬ tions. This was accompanied by evident pain, defeca¬ tion, and urination. It then became apparent that Francisco 94122. flaccid paralysis of both lower extremities was pres¬ ent with loss of sphincter control of both bladder and rectum. The apical pulse was 150. Blood pressure was reportedly normal. One hundred milligrams of hydrocortisone was given intramuscularly, 50 mg into each arm. During the next hour the right lower extremity became cyanotic and blotchy; thereafter, the normal color returned gradually.A neurological surgeon performed a lumbar punc¬ ture with normal findings of pressure, cell count, and protein. Results of x-rays of the thoracic and lumbar spine and hips were negative. By the following morning he was comfortable ; oral fluids were well tolerated, temperature was normal, pulse was 80 beats per minute, and respira¬ tions were 40 per minute. An indwelling Foley catheter was in place, and the patient had normal urinary output.He was admitted to H. C. about 18 hours following injection. There had been no observable change in the paralysis of both lower extremities, and loss of sensation to pain was noted below the level of the umbilicus.On entry he was found to be a beautifully devel¬ oped, well-nourished boy of 15 months. His weight was 21 lb 14 oz (9.9 kg) ; temperature was 36 C (96.8 F) ; pulse, 120; respirations, 30; and systolic blood pressure (flush), 100. Physical findings were limited to the areas previously described and he did not appear generally ill. The tonsils showed moder¬ ate infection, and a mild otitis media was present on the right side. Ecchymotic areas were present over both buttocks, especially over the right...