title: Gluteal abscess and bacteremia following promethazine injection in a Marine.
abstract: Intramuscular injection is routinely used and rarely leads to adverse events such as abscess or tissue necrosis. Intramuscular promethazine has been documented to cause these problems. We discuss the case of a previously healthy 19-year-old U.S. Marine, who was diagnosed with methicillin sensitive Staphylococcus aureus bacteremia and abscess formation after receiving intramuscular promethazine for vomiting. After confirmation of abscess formation via magnetic resonance imaging, he underwent percutaneous drainage. He improved and was treated with 6 weeks of cefazolin. This case demonstrates an unusual and severe adverse reaction associated with intramuscular promethazine administration. Additionally, this case highlights the importance of proper antiseptic technique before promethazine administration and calls into question the utility and safety of intramuscular promethazine when oral dissolving antiemetic medications are available.
authors.affiliation: Internal Medicine Residency Program, Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Scott
authors.initials: S
authors.lastname: Snyder
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Andrew
authors.initials: A
authors.lastname: Letizia
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Joshua
authors.initials: J
authors.lastname: Hartzell
mesh_terms: D000038:Abscess / Q000209:etiology*; D016470:Bacteremia / Q000209:etiology*; D002081:Buttocks; D006634:Histamine H1 Antagonists / Q000008:administration & dosage; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects; D008297:Male; D008889:Military Personnel; D018482:Muscle, Skeletal; D009326:Naval Medicine; D011398:Promethazine / Q000008:administration & dosage; D013203:Staphylococcal Infections / Q000209:etiology*; D013211:Staphylococcus aureus; D014481:United States; D055815:Young Adult
chemical_list: D006634:Histamine H1 Antagonists; D011398:Promethazine