Tachon Syndrome: Rare Side Effect of Articular Injections of Corticosteroids. A Report of Two Cases

Abstract

Epidural or intra-articular injections of corticosteroids are an option for the treatment of several pain conditions but are not without adverse effects. Here, we discuss a rare systemic side effect of this therapy: Tachon syndrome. We report two cases, a 64-year-old woman and a 43-year-old man, who presented with Tachon syndrome after receiving, respectively, a shoulder and a lumbar injection of cortivazol 3.75 mg/1.5 ml suspension for injection in pre-filled syringes. The indication for this therapy was, respectively, tendinopathy of the supraspinatus and a mechanical L5 lumbosciatica. A few minutes after receiving the injection, patients experienced acute low back pain, chest tightness, facial erythema and profuse sweating. All vital and biologic parameters were normal. In the first case, improvement was spontaneous and all symptoms resolved in 20 min. The second patient remained under observation and received an intravenous ‘physiological’ infusion. Both patients recovered fully and returned home. A causal relationship between the corticosteroid injections and the patients’ symptoms was very likely because of the acute clinical presentation and the rapid improvement in the patients’ conditions and that no further signs indicating other serious complications developed.Electronic supplementary materialThe online version of this article (10.1007/s40800-017-0062-z) contains supplementary material, which is available to authorized users.

Post-injection Complications. Nicolau Syndrome as a Consequence of Local Irritant Effects of Drugs, Including Antiseptics, Local Anesthetics, NSAIDs, Steroids and Anticoagulants

“…None of these patients were known to have allergies, and only 2% developed urticaria. The outcome was favorable in all cases [24].…”

“…In addition, another complication of steroid injection has been described: Tachon's syndrome [23][24][25]. It is thought that Tachon's syndrome may be a venous analogue of Nicolau syndrome (corticosteroid injection into an artery).…”

Emerging Trend in the Pharmacotherapy of Osteoarthritis

“…Therefore, the benefits of IA injections of corticosteroids remain unclear, and further research is required. The reported side effects of IA injections of corticosteroids are mostly post-injection pain and flushing, septic arthritis, and some rare cases of Tachon Syndrome (36, 37). Chronic use of corticosteroids has been reported to induce osteoporosis in children with 21-hydroxylase deficiency (38).…”

Thermal imaging of local skin temperature as part of quality and safety assessment of injectable drugs

“…Additionally, Nicolau syndrome can develop after injections of local anesthetics, steroids, nonsteroidal anti-inflammatory drugs, chemotherapeutic agents, vaccines, and a combination of drugs [ 20 , [36] , [37] , [38] , [39] ]. Tachon syndrome, similar to Nicolau syndrome, describes post-injection complications of steroid injection into an artery and vein [ [40] , [41] , [42] ].…”