The recent meningitis outbreaks from contaminated injected steroids have made front page news. Now, some of those infected have developed a serious secondary skin infection.
Epidural abscesses have erupted at the site where the steroids were originally injected near the spine to treat back or neck pain. Despite patients having received potent antifungals to treat their meningitis, these new abscesses have forced patients to return to the hospital for more IV medication and possibly surgery.
An epidural abscess and meningitis are different infections. An abscess is a localized infection that becomes filled with pus. Meningitis is an inflammation of the membrane layers that cover the spinal cord and the brain.
According to Dr. Lakshmi K. Halasyamani, chief medical officer at St. Joseph Mercy Hospital in Ann Arbor Michigan, about one-third of the 53 patients they treated have returned with abscesses.
Some patients, 34 cases, who did not develop meningitis from the contaminated steroid injections have developed abscesses and are being treated at St. Joseph’s Mercy hospital. There are reports in Tennessee that a few of their patients have also developed abscesses.
The main symptom is severe pain near the injection site but the abscesses form inside the spinal area so are not apparent when examining the skin. An MRI is needed to make the diagnosis and some patients have been found to have more than one abscess.
The concern is that these patients could develop meningitis caused directly by the abscesses.
Treatment of the spinal abscesses is challenging. Draining an abscess or having it cleaned out by a neurosurgeon can resolve some of the cases. However in other cases “the fungal strands and abnormal tissue become wrapped around the spinal nerves and cannot be surgically removed”, reported Dr. Carol A. Kauffman, an expert on fungal diseases at University of Michigan.
Those cases are treated with combinations of antifungal drugs in the hopes that the infection can be halted. Doctors do not have much experience dealing with this type of complicated infection. Meningitis caused by fungus is very rare.