Tachon Syndrome: Rare Side Effect of Articular Injections of Corticosteroids. A Report of Two Cases
Tóm tắt
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.
Tài liệu tham khảo
Berthelot JM, Tortellier L, Guillot P, Prost A, Caumon JP, Glemarec J. Tachon’s syndrome (suracute back and/or thoracic pain following local injections of corticosteroids). A report of 318 French cases. Jt Bone Spine. 2005;72(1):66–8.
Maillefert JF, Aho S, Huguenin MC, Chatard C, Peere T, Marquignon MF, et al. Systemic effects of epidural dexamethasone injections. Rev Rhum. 1995;62(6):429–32.
Abram SE, O’Connor TC. Complications associated with epidural steroid injections. Reg Anesth. 1996;21(2):149–62.
Daragon A, Vittecoq O, Le Loet X. Visual hallucinations induced by intra-articular injection of steroids. J Rheumatol. 1997;24(2):411.
Hunter A, Blyth TH. A risk-benefit assessment of intra-articular corticosteroids in rheumatic disorders. Drug Saf. 1999;21(5):353–65.
Webster BH. Clinical presentation of haemolytic transfusion reactions. Anaesth Intensive Care. 1980;8(2):115–9.
Ballas SK. Sickle cell aneamia: progress in pathogenesis and treatment. Drugs. 2002;62(8):1143–72.
Friedman HD, Noonan M. Acute Gram-negative urosepsis mimicking an acute hemolytic transfusion reaction. Transfusion. 1996;36(5):460–5.
Kumar N, Newman RJ. Complications of intra and periarticular steroid injections. Br J Gen Pract. 1999;49(443):465–6.
DeSio JM, Kahn CH, Warfield CA. Facial flushing and/or generalized erythema after epidural steroid injection. Anesth Analg. 1995;80(3):617–9.
Berthelot JM, Le Goff B, Maugars Y. Side effects of corticosteroid injections: what’s new? Jt Bone Spine. 2013;80(4):363–7.
Mcgraft JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011;12(5):726–31.
Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Hanna A, Rittenberg J. Complications of fluoroscopically guided caudal epidural injections. Am J Phys Med Rehabil. 2001;80(6):416–24.
Hajjioui A, Nys A, Poiraudeau S, Revel M. An unusual complication of intra-articular injections of corticosteroids: Tachon syndrome. Two case reports. Ann Readapt Med Phys. 2007;50(9):721–3 (718–20).
Mace S, Vadas P, Pruzanski W. Anaphylactic shock induced by intraarticular injection of methylprednisolone acetate. J Rheumatol. 1997;24(6):1191–4.
Montoro J, Valero A, Serra-Baldrich E, Amat P, Lluch M, Malet A. Anaphylaxis to paramethasone with tolerance to other corticosteroids. Allergy. 2000;55(2):197–8.
Laredo J, Laemmel E, Vicaut E. Serious neurological events complicating epidural injections of glucocorticoid suspensions: evidence for a direct effect of some particulate steroids on red blood cells. RMD Open. 2016;2(2):e000320.