[Medical emergencies following dermatological injections and infusions].
Emergency situations following appropriately administered injections and infusions are an uncommon dermatologic problem. Embolia cutis medicamentosa is an uncommon complication following intramuscular injection which leads to infarct-like cutaneous necrosis. It may develop after gluteal injection of corticosteroids, anti-inflammatory agents and antibiotics and has rarely been described following venous sclerotherapy with polidocanol. Hoigné syndrome is a pseudoanaphylactic or pseudoallergic reaction following intramuscular injection of procaine penicillin, with neuropsychiatric problems developing immediately after the injection. Subacute forms following intramuscular or oral administration of structurally-related antibiotics. The intraoperative use of patent blue dye has a 1-2% risk of allergic reactions. The patient must be monitored carefully following injection for the onset the life-threatening immediate reaction. Extravasation of cytostatic agents is a critical iatrogenic problem in oncology with an incidence of up to 6.5%. Every oncologic department should have an understanding of necrotic risk of the various agents and an emergency kit with instructions for immediate steps, also including agent-specific antidotes as available.
Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar. haddil@uniklinik-saarland.de
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Dill-Müller
D000707:Anaphylaxis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D000970:Antineoplastic Agents / Q000009:adverse effects; D003287:Contrast Media / Q000009:adverse effects; D003875:Drug Eruptions / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004630:Emergencies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology / Q000628:therapy; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects*; D007267:Injections / Q000009:adverse effects*; D007273:Injections, Intramuscular / Q000009:adverse effects; D009336:Necrosis; D010406:Penicillins / Q000009:adverse effects; D012394:Rosaniline Dyes / Q000633:toxicity; D012867:Skin / Q000187:drug effects / Q000473:pathology; D013577:Syndrome
D000970:Antineoplastic Agents; D003287:Contrast Media; D010406:Penicillins; D012394:Rosaniline Dyes; C008769:sulfan blue