Triamcinolone
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Infectious arthritis and aspergillosis following intraarticular administration in an elderly patient: case report An 84-year-old woman developed infectious arthritis and disseminated aspergillosis, after intra-articular injections of triamcinolone for an arthritic knee. She subsequently died. The woman presented with knee pain, and was treated with several corticosteroid injections [exact drugs not specified] and NSAIDs, with little improvement. In September 2005 synoviorthesis was performed with triamcinolone [Hexatrione; dosage not stated], and after mild improvement she was diagnosed with inflammatory arthritis. One month later synoviorthesis was performed again with triamcinolone due to further pain. In November 2005, she was hospitalised with a fever and an inflamed knee with effusion and no motion. Her WBC count was elevated, her C-reactive protein level was 307 mg/L and there was hyperfibrinogenaemia. The woman was initiated on amikacin and oxacillin for a suspected infection. Fluid taken from an arthroscopy isolated the cause as A. fumigatus. Severe sepsis and an altered level of consciousness were also present, and secondary disseminated aspergillosis with antigenaemia was apparent. She was treated with voriconazole. Surgery for debridement revealed destructive osteoarthritis of the knee, tibia and femur with bone resorption, as well as femur and tibia fractures. Her left lower limb was amputated 5 days later, and bone samples displayed purulent Aspergillus osteomyelitis. The fever resolved but her overall condition deteriorated. She died 2 days after the amputation, following multiple organ failure. Author comment: An iatrogenic origin of her septic arthritis due to Aspergillus is more than likely, because the injections and the knee joint punctures were performed before Aspergillus was isolated, and there were no signs of disseminated aspergillosis before the joint disease was discovered. The corticosteroid injections caused local immunosuppression, which, in association with the advanced age of the patient, probably facilitated the development of the infection. Durox H, et al. Disseminated aspergillosis after intra-articular corticosteroid infiltrations. Medecine et Maladies Infectieuses 37: 609-612, No. 9, Sep 2007 801096134 [French; summarised from a translation] - France
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Reactions 19 Jan 2008 No. 1185
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