Tachon's syndrome (suracute back and/or thoracic pain following local injections of corticosteroids). A report of 318 French cases.
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).
Berthelot
Jean-Marie
JM
Rheumatology Unit, CHU Nantes University Hospital, 44093 Nantes cedex 1, France. jeanmarie.berthelot@chu-nantes.fr
Tortellier
Laetitia
L
Guillot
Pascale
P
Prost
Alain
A
Caumon
Jean-Pierre
JP
Glemarec
Joëlle
J
Maugars
Yves
Y
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
D000305:Adrenal Cortex Hormones