title: Tachon's syndrome (suracute back and/or thoracic pain following local injections of corticosteroids). A report of 318 French cases.
abstract: OBJECTIVE
  To assess the frequency, features, and outcome of excruciating lumbar, dorsal, and/or thoracic pain following injections of local corticosteroids in rare instances.
  
  
  METHODS
  A questionnaire mailed to 500 French rheumatologists.
  
  
  RESULTS
  Three hundred and eighteen cases were reported by 92 rheumatologists (one event per 8000 injections or 6.5 years of practice), following injections into lumbar epidural space (39%), an upper limb (30%), a lower limb (mostly the heel) (24%), or other locations (7%), of cortivazol (67%), hydrocortisone (25%), betamethasone (7%), or paramethasone (1%). Symptoms occurred 1-5 min (78%) or less than 1 min (22%) after injection, and highly acute axial pain usually lasted for less than 5 min (34%) or 5-15 min (51%). In addition to pain in lumbar (84%) and/or dorsal regions (25%) [often preceded or associated with thoracic pain (36%)], other signs were: anxiety (87%), shortness of breath (64%), facial flushing (64%), diffuse sweating (41%), agitation (29%), transient cough (23%), abdominal pain (20%), transient hypertension (15%), paleness (10%), hypotension (8%), diarrhoea (3%) and headache (3%). None of these patients was known to be allergic, and urticaria developed in only 2%. Outcome was favourable in all cases (even though 4/318 patients were transiently hospitalised) with an overall duration of 25 +/- 71 min. Another injection was performed later in 146/318 cases (46%), but Tachon's syndrome recurred in only 20 of these 146 patients (14%).
  
  
  CONCLUSIONS
  The outcome of this impressive syndrome seems excellent. Tachon's syndrome might be the venous counterpart of Nicolau's syndrome (injection of corticosteroids in an artery).
authors.affiliation: Rheumatology Unit, CHU Nantes University Hospital, 44093 Nantes cedex 1, France. jeanmarie.berthelot@chu-nantes.fr
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Berthelot
authors.forename: Laetitia
authors.initials: L
authors.lastname: Tortellier
authors.forename: Pascale
authors.initials: P
authors.lastname: Guillot
authors.forename: Alain
authors.initials: A
authors.lastname: Prost
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Caumon
authors.forename: Joëlle
authors.initials: J
authors.lastname: Glemarec
authors.forename: Yves
authors.initials: Y
authors.lastname: Maugars
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D001416:Back Pain / Q000139:chemically induced*; D002637:Chest Pain / Q000139:chemically induced*; D005260:Female; D005602:France; D006801:Humans; D007268:Injections, Epidural; D015552:Injections, Intralesional; D008297:Male; D012216:Rheumatic Diseases / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D014581:Urticaria / Q000139:chemically induced
chemical_list: D000305:Adrenal Cortex Hormones