514 - A Series of Catastrophic Events Following Routine Corticosteroid Injections for Knee Osteoarthritis

Case Diagnosis: Bilateral septic arthritis amongst widespread bacterial seeding following corticosteroid injection

Case Description: A healthy 66-year-old male underwent bilateral knee corticosteroid injections for osteoarthritis. In the week following, the patient experienced worsening knee and back pain not alleviated with conservative measures. Upon presentation to the emergency department, he was found to have signs of active infection prompting hospital admission where workup revealed bacterial seeding across multiple sites. Spine imaging showed an epidural abscess of the thoraco-lumbar spine and psoas muscle requiring urgent laminectomy and debridement. Chest imaging demonstrated a loculated pleural effusion requiring surgical intervention and chest tube placement. Bilateral knee arthroscopies were completed for drainage of septic arthritis. Despite several surgeries and antibiotics, blood cultures remained positive for MSSA bacteremia, and the patient was evaluated for urgent mitral valve replacement due to concerns for endocarditis on echocardiogram. Fortunately, valve replacement was ultimately not required due to improvement on further antibiotics. Following medical stability, the patient was discharged to an inpatient rehabilitation facility.

Discussions: While considered a conservative measure, peripheral joint injections do carry risks which should be discussed with patients and weighed against the potential benefits. This case highlights an exceedingly rare but serious complication of a generally well-tolerated outpatient procedure. Furthermore, it emphasizes the importance of aseptic technique when preparing for and completing joint injections to minimize the risks of such adverse event for the patient.

Conclusions: Life threatening complications following corticosteroid injections are uncommon and have been mitigated by several commonplace practices; however, this case demonstrates a catastrophic scenario and serves as a grave reminder to clinicians to maintain these practices and closely monitor post-procedural symptoms.