Reactions 1680, p309 - 2 Dec 2017
Infections and pain: 2 case reports
Two patients were reported (44-year-old woman and
42-year-old man), who developed pain and infections
following sodium thiosulfate injections.
Case 1: A 44-year-old woman developed tumoral calcinosis
(TC) of right elbow and forearm and the two ischiatic regions.
In spite of treatment with various drugs, TC progressed.
Therefore, she started to receive intra-lesional injections of
sodium thiosulfate weekly [dose not stated], in
November 2015. During the sessions, multiple injections were
administered around TC. The total volume ranged from 1-3g,
depending upon her tolerance. The first session was painful.
Therefore, for subsequent sessions, she was premedicated
with painkillers and local lidocaine anaesthesia patch was
used. During the fifth month of treatment, 48 hours after the
injection, she developed a subcutaneous infection. She was
successfully treated with anti-staphycoccal antibiotics [specific
drugs not stated].
Case 2: A 42-year-old man had familial hyperphosphatemic
TC on the right side of the left tibia and another lesion in the
right buttock. He was receiving topical sodium thiosulfate for
the tibial lesion, which nearly disappeared. However, the
topical treatment was not efficient for the buttock lesion.
Therefore, he was given multiple local injections of sodium
thiosulfate around the pseudocyst, weekly [dose not stated].
He experienced pain during the injections; therefore, lidocaine
patches were used before the injections. The frequency of
injections was reduced to two weeks a month and then
stopped from month 10 to month 15, due to injection-
associated pain. During the 21 months of treatment, he
developed two infections [duration of treatment to reactions
onset not stated]. The causative organism was found to be
Streptococcus agalactiae, and the infections were controlled
effectively by appropriate antibiotics [specific drugs not stated].
Author comment: "We observed no side effects, except a
subcutaneous infection occurring 48h after an injection
during the fifth month." "The first session of injections was
painful." "Injections were preceded by application of lidocaine
patches to limit injection-related pain. "However, the local
reaction induced by [sodium thiosulfate] could favour a local
bacterial graft and therefore infection."
Goossens J, et al. Efficacy of intralesional sodium thiosulfate injections for
disabling tumoral calcinosis: Two cases. Seminars in Arthritis and Rheumatism 47:
451-455, No. 3, Dec 2017. Available from: URL: http://doi.org/10.1016/
j.semarthrit.2017.05.013c - France
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved