Acute paraplegia and pulmonary edema after benzathine penicillin injection

Christophe Lelubre; Philippe E.R. Lheureux

doi:10.1016/j.ajem.2007.04.013

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Acute paraplegia and pulmonary edema after benzathine penicillin injection

Christophe Lelubre, MD

Philippe E.R. Lheureux, MD, PhD

Department of Emergency Medicine, Erasme University Hospital, Université Libre de Bruxelles, B-1070 Brussels, Belgium

DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.013

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Fig. 1

The chest x-ray revealed pulmonary edema.

Fig. 2

Dorsolumbar MRI (sagittal T2-weighted image) showing hyperintense signal from T7 through T9 suggestive of syringomyelia syrinx (arrow).

Fig. 3

T1-weighted transverse MRI at the T7 level shows the hyposignal, central, intramedullary lesion consistent with syringomyelia.

Fig. 4

Saggital T1-weighted MRI of the dorsolumbar spine shows (A) a hypodense, central, intramedullary lesion from T7 through T9 consistent with syrinx and (B) enlargement of the cord suggestive of cord edema.

Accidental intra-arterial injection is a potentially devastating complication of the intragluteal injection of benzathine penicillin. A 35-year-old woman developed after intramuscular injection of benzathine penicillin G acute paraplegia and noncardiogenic pulmonary edema. Noninvasive positive pressure ventilation was initiated with furosemide and corticosteroids. A magnetic resonance imaging scan showed findings consistent with syringomyelia and spinal cord ischemia at T9 through T10. Vascular injury may be the result of microemboli of the injected crystals of the penicillin salts.

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Acute paraplegia and pulmonary edema after benzathine penicillin injection

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