Magnetic Resonance Imaging Screening to Identify Spinal and Paraspinal Infections Associated With Injections of Contaminated Methylprednisolone Acetate

Authors:
  • DVDavid M. Vandenberg
    David M. Vandenberg
  • BSBonita Singal
    Bonita Singal
  • MKMichael Kasotakis
    Michael Kasotakis
  • SKSpencer Koch
    Spencer Koch
  • VMVarsha Moudgal
    Varsha Moudgal
  • RJRajasekhar Jagarlamudi
    Rajasekhar Jagarlamudi
  • ANAnupama Neelakanta
    Anupama Neelakanta
  • MOMichael H. Otto
    Michael H. Otto
  • LHLakshmi Halasyamani
    Lakshmi Halasyamani
  • RKRami Kaakaji
    Rami Kaakaji
  • CKCarol A. Kauffman
    Carol A. Kauffman
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Abstract
Fungal contamination of methylprednisolone prepared by a compounding pharmacy resulted in an unprecedented multistate outbreak of meningitis in the fall of 2012.1-4 Michigan has had the highest state-specific attack rate for fungal infection associated with the contaminated spinal or paraspinal injections.5,6 Initially, these injections were complicated by meningitis. Within 6 weeks of the outbreak, meningitis became less frequent and localized spinal and paraspinal infections became the principal manifestations of contaminated steroid injections. In contrast to the relatively brief period in which meningitis cases appeared, a steady stream of spinal and paraspinal infections continue to present long after the injections were last administered.

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