AcuteTransverse Myelopathy Caused by Penicillin Injection

Abstract

A case of acute transverse myelopathy with anaesthesia and flaccid paralysis of both lower limbs, following intragluteal penicillin injection, is reported. This accident was probably due to a mistaken intra-arterial injection of the drug with retrograde progression through branches of the internal iliac artery up to the spinal cord. The treatment of such events in all the cases reported by the literature has been disappointing. Therefore, particular precautions must be taken in case of intramuscular penicillin injection, according to the present and the previous cases described, in order to avoid such accidents.

Acute transverse myelitis due to Coxsackie virus

“…The rash was not the typical copper-colored rash observed when patients with infectious mononucleosis have been treated with amoxicillin or ampicillin and also was not typical for measles or rubella. Although myelitis is a rare complication of intramuscular penicillin, 15 it has not been reported in patients treated with amoxicilcin. There was no lymphadenopathy or hepatosplenomegaly which can be seen in infections with EBV, cytomegalovirus (CMV) infection and rubella.…”

Differential Diagnosis of Acute Flaccid Paralysis and its Role in Poliomyelitis Surveillance

“…A slightly elevated protein level in cerebrospinal fluid may be found. There have been reports of acute transverse myelitis with sensory disturbances and AFP of both lower limbs following intragluteal penicillin injection (108). These accidents were probably due to mistaken intraarterial injection of the drug, with retrograde progression through branches of the internal iliac artery up to the spinal cord.…”

Incidence of Acute Transverse Myelitis in Rochester, Minnesota, 1970–1980, and Implications with Respect to Influenza Vaccine

“…The pro cess may begin acutely in a few hours or less, or develop subacutely over a period of several days [2], Early in this century, the illness was attributed to vascular disorders, including syphilis, atherosclerosis, and infection [3]. As additional cases were reported, other neuropathologic processes were identified and related to other possible etiologies, including parainfectious inflammatory disor ders [4][5][6][7][8], postvaccinal reactions [9][10][11][12][13][14][15], effects of chemicals and radiation [16][17][18], vascular malformations [19], demyelination as part of multiple sclerosis [20], and necrotic myelopathy as a remote effect of cancer [21,22], Early attempts to define acute transverse myelitis clinically come from sur veys of hospitalized patients [2,[23][24][25] in which the clinical criteria were usually as follows: acute nonrecurrent onset of bilateral, not always symme trical, cross-sectional sensorimotor deficit. Cases thought to be due to known systemic or focal neurologic disorders affecting the cord were usually excluded.…”