Fungal Meningitis after ILESI

[SpineandWine]

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I had a hospital admin pop by and stated a patient I had done an injection on was hospitalized for Fungal meningitis a week after an injection

Wouldn’t tell me name or DOB.
Any idea how it could occur? I would not inject at site of skin infection.
Presumably not on antifungal medications.

They wouldn’t tell me more information on story.

 

[paindoc007]

I had a hospital admin pop by and stated a patient I had done an injection on was hospitalized for Fungal meningitis a week after an injection

Wouldn’t tell me name or DOB.
Any idea how it could occur? I would not inject at site of skin infection.
Presumably not on antifungal medications.

They wouldn’t tell me more information on story.

Goodness. That’s scary. Hope they recover smoothly

 

[Ducttape]

Remember the fungal meningitis outbreak caused by NECC steroid from compounded steroids...



Edit best you do not answer this post but if you did, other actions required.

 

[willabeast]

I had a hospital admin pop by and stated a patient I had done an injection on was hospitalized for Fungal meningitis a week after an injection

Wouldn’t tell me name or DOB.
Any idea how it could occur? I would not inject at site of skin infection.
Presumably not on antifungal medications.

They wouldn’t tell me more information on story.

Fungal meningitis was a big problem a few years ago because of one compounding pharmacy making steroids used by docs for epidurals.

 

[SpineandWine]

I’ll post more when i find out
Think they are waiting to get family permission before sharing but has anyone have this or heard of anything similar
I used depomedrol- last heard caused meningitis 2012

I doubt it’s a depo vial issue- lot of people know about this.
How can one prevent this?


I’m running through the thoughts here but I don’t do injections on patients who have fevers or chills.
I don’t inject through back rash.

 

[SSdoc33]

meningitis was already there. you didnt cause it, especially not after a week.

you need to dig into the case. i bet there is a fungal source elsewhere. skin or lungs

it is possible, but a very very rare complication

 

[Agast]

They are not waiting for family permission, they’re trying to manage the liability and don’t want you poking around the chart possibly editing things or looking guilty. All chart access attempts are discoverable in court.

 

[Agast]

Literally the only reason not to inform the doctor the identity of the patient, is to try to retain control of the doctor’s actions for as long as possible

 

[SpineandWine]

I guess there is nothing to do here.
I am not sure what I could have done to prevent it. Will await further instructions.

I’d never change something after the fact. As any edits or clicks even are recorded in EMR

 

[Ducttape]

If you are using compounded steroids, stop now and contact authorities such as department of health of your state.

If you are doing injections in your office, consider doing a deep cleaning.

Most likely it is unfortunate timing and circumstance and nothing you could have anticipated.

 

[SpineandWine]

If you are using compounded steroids, stop now and contact authorities such as department of health of your state.

If you are doing injections in your office, consider doing a deep cleaning.

Most likely it is unfortunate timing and circumstance and nothing you could have anticipated.

HOPD- they already cleaned the area

 

[SpineandWine]

If you are using compounded steroids, stop now and contact authorities such as department of health of your state.

If you are doing injections in your office, consider doing a deep cleaning.

Most likely it is unfortunate timing and circumstance and nothing you could have anticipated.

Not compounded

 

[Agast]

Next time skip the mushrooms in your omelette

 

[interjectionreflection]

I hope the patient is okay. If you used sterile techniques infection is a recognized risk of injection and presumably the patient understood and agreed to this. Also fungal is odd, I would look at other risk factors for immunocompromised RF as well. Not saying it's impossible but I don't think having an infection always means something wrong happened. Of course review your practice patterns and learn from it.

 

[Laryngospasm]

Scary.. I’ve been through something similar although not fungal which is super rare and likely not related to your injection. Temporal relationship as well as other procedures and health issues likely very important here. As long as your documentation was on par there’s really nothing for you to do or worry about. If this becomes very stressful you feel free to reach out and take care of yourself and your mental health.

 

[SpineandWine]

So found name and DOB.
It was after a kyphoplasty, not ESI
Which oddly enough is outside epidural space. I am hoping this is just councidence

Anyone have experience with this. I heard her prognosis is not looking good in ICU

 

[jsaul]

Unfortunately you will be blamed for this. Having worked with lawyers for the past 7 years i fear that to be the case. The hospital is trying to mitigate. The lawyers will say the equipment or bone cement was contaminated due to error. That then seeded the meninges

 

[bedrock]

Unfortunately you will be blamed for this. Having worked with lawyers for the past 7 years i fear that to be the case. The hospital is trying to mitigate. The lawyers will say the equipment or bone cement was contaminated due to error. That then seeded the epidural space

That’s helpful info.

And a good reminder to cancel procedures on sick patients if their health is anything but optimal. We aren’t removing tumors, everything we do is elective.

 

[lobelsteve]

So found name and DOB.
It was after a kyphoplasty, not ESI
Which oddly enough is outside epidural space. I am hoping this is just councidence

Anyone have experience with this. I heard her prognosis is not looking good in ICU

Did you use cement?
Can the fungus survive the toxic and thermal milieu of the procedure?
Easily defended.

Here is your case report:

Rare case of post-vertebroplasty fungal spondylodiscitis:... : Indian Spine Journal

e objective of this clinical case report was to highlight this rare fungal spondylodiscitis following vertebroplasty. A 67-year-old woman was diagnosed with osteoporotic compression fracture for which vertebroplasty was done. During the procedure, the primary surgeon noticed the cement leakage...

journals.lww.com

 

[clubdeac]

Crap sorry to hear that even though sounds unlikely related to what you did

I was going to post a new thread, but this might be a good place to ask the group, what’s the best way to protect your assets an exorbitant medical malpractice verdict? Like should I put everything I own in my wife’s name? Would that be sufficient?

 

[SSdoc33]

Crap sorry to hear that even though sounds unlikely related to what you did

I was going to post a new thread, but this might be a good place to ask the group, what’s the best way to protect your assets an exorbitant medical malpractice verdict? Like should I put everything I own in my wife’s name? Would that be sufficient?

So thats why you got married? As a risk management technique? I back it

 

[clubdeac]

So thats why you got married? As a risk management technique? I back it

Exactly! 🤣

 

[Laryngospasm]

Crap sorry to hear that even though sounds unlikely related to what you did

I was going to post a new thread, but this might be a good place to ask the group, what’s the best way to protect your assets an exorbitant medical malpractice verdict? Like should I put everything I own in my wife’s name? Would that be sufficient?

Consult an attorney for your state.. probably an irrevocable trust or offshore trust of some type. Or gold bars after you develop a “gambling problem”

 

[SpineandWine]

I don’t think they’re suing.
She’s 90 year old, really not anything of my fault

 

[DOctorJay]

Crap sorry to hear that even though sounds unlikely related to what you did

I was going to post a new thread, but this might be a good place to ask the group, what’s the best way to protect your assets an exorbitant medical malpractice verdict? Like should I put everything I own in my wife’s name? Would that be sufficient?

No bro, it all goes in your mom’s name!

 

[Baron S]

Crap sorry to hear that even though sounds unlikely related to what you did

I was going to post a new thread, but this might be a good place to ask the group, what’s the best way to protect your assets an exorbitant medical malpractice verdict? Like should I put everything I own in my wife’s name? Would that be sufficient?

What you are looking for is a Trust.

 

[specepic]

Thank you for sharing the case

 

[geauxg8rs]

What do you use to cleanse the skin, chloraprep, betadine? I’m just curious.

When i was working at an hopd 10 years ago the hospital was using betadine and wouldn’t let me use chloraprep because they claimed it was neurotoxic and had to use betadine. I told them that i wanted the best agent to clean skin and that chloraprep was superior, that the Mayo Clinic used it on their spinal injections. I closed with throwing the hospital under the bus if i got an infection. They relented.

 

[lobelsteve]

I don’t think they’re suing.
She’s 90 year old, really not anything of my fault

Fault is something found at end of a trial.
Being named in the suit is as bad as losing. That's why we have insurance.

 

[Ducttape]

the best risk management technique is to have a good relationship with the patient and the family.

s*&t happens. especially when one is 90. but lawsuits are a lot less likely to happen if the patient believes the doctor did what was in their best interest and still has their best interest at heart.

 

[SSdoc33]

the best risk management technique is to have a good relationship with the patient and the family.

s*&t happens. especially when one is 90. but lawsuits are a lot less likely to happen if the patient believes the doctor did what was in their best interest and still has their best interest at heart.

translation: you have to kiss their ass even though you did nothing wrong.

 

[SpineandWine]

What do you use to cleanse the skin, chloraprep, betadine? I’m just curious.

When i was working at an hopd 10 years ago the hospital was using betadine and wouldn’t let me use chloraprep because they claimed it was neurotoxic and had to use betadine. I told them that i wanted the best agent to clean skin and that chloraprep was superior, that the Mayo Clinic used it on their spinal injections. I closed with throwing the hospital under the bus if i got an infection. They relented.

Chlorhexidine, full gown/gloves, c armor - whole shebang with IV abx

 

[MitchLevi]

I think it is most likely there’s no one to blame for this and nature is gonna nature.

 

[au bon pain]

Anyone have experience with this. I heard her prognosis is not looking good in ICU

Fungal infections (outside of skin stuff and yeast infections) are unfortunately often really tough to treat and IV anti-fungals can cause their own issues.

Sounds like you did nothing wrong and maybe the patient had some smoldering pulmonary crypto and unlucky **** transpired.

 

[pastafan]

I was going to post a new thread, but this might be a good place to ask the group, what’s the best way to protect your assets an exorbitant medical malpractice verdict? Like should I put everything I own in my wife’s name? Would that be sufficient?

Besides shielding assets, I have seen the strategy below utilized. The requirement was for the insured to demand that the insurance company settle for the policy limits. If they refuse, which is their right, then the insurance company is on the hook for losses above that amount.

Bad Faith Duty to Settle
Beyond these state-specific programs, virtually all states impose a “duty to settle” or “duty of good faith” on insurance companies. This legal doctrine can provide protection to physicians even without specific statutory limitations:
How it works: If an insurance company receives a settlement offer within policy limits and the insurer reasonably should accept it (based on the likelihood of an excess verdict), but the insurer refuses and a jury later awards damages exceeding policy limits, the insurance company—not the physician—may be held liable for the full amount of the excess judgment.
The protection: This doctrine, known as “Stowers” doctrine in Texas and similar names elsewhere, creates strong incentives for insurers to settle meritorious claims within policy limits. If the insurer acts in bad faith by rejecting a reasonable settlement offer, the insurer becomes primarily liable for any excess judgment.
State application: This bad faith framework exists in some form in nearly every state, though the specific standards vary. Some states require proof of negligence, others require recklessness, and still others require intentional wrongdoing by the insurer.

 

[manowar rules]

Did you use cement?
Can the fungus survive the toxic and thermal milieu of the procedure?
Easily defended.

Here is your case report:

Rare case of post-vertebroplasty fungal spondylodiscitis:... : Indian Spine Journal

e objective of this clinical case report was to highlight this rare fungal spondylodiscitis following vertebroplasty. A 67-year-old woman was diagnosed with osteoporotic compression fracture for which vertebroplasty was done. During the procedure, the primary surgeon noticed the cement leakage...

journals.lww.com

This is interesting. A couple things I note:

1) Happened around Mumbai India, not sure how their sterile technique is (MRIs were good quality though)
2) Cement placement sloppy
3) Case report patient never got meningitis, and took 2 months of slowly increasing back pain to get osteolyelitis diagnosis
4) On axial MRI post-kypho that showed infected vertebrae, infection did not seem to spread around big ball of cement that had leaked to paravertebral region. So maybe a dirty instrument rather than dirty cement.

In the original case posted above, it seems like mistaking correlation for causation. Vertebral osteomyelitis can spread to the epidural space and CSF, it just seems unlikely to all happen within the space of a week when there has been no violation into the dura. Most cases of post-procedural meningitis happen after an accidental durotomy.

I have been sent multiple "compression fractures" for kypho that ended up being osteomyelitis upon work-up. I wonder if that might be the case here, and what else was going on with the 90 y/o's health.

Sorry for the stress @SpineandWine, that sucks! Glad the family seems understanding.

 

[clubdeac]

This is interesting. A couple things I note:

1) Happened around Mumbai India, not sure how their sterile technique is (MRIs were good quality though)
2) Cement placement sloppy
3) Case report patient never got meningitis, and took 2 months of slowly increasing back pain to get osteolyelitis diagnosis
4) On axial MRI post-kypho that showed infected vertebrae, infection did not seem to spread around big ball of cement that had leaked to paravertebral region. So maybe a dirty instrument rather than dirty cement.

In the original case posted above, it seems like mistaking correlation for causation. Vertebral osteomyelitis can spread to the epidural space and CSF, it just seems unlikely to all happen within the space of a week when there has been no violation into the dura. Most cases of post-procedural meningitis happen after an accidental durotomy.

I have been sent multiple "compression fractures" for kypho that ended up being osteomyelitis upon work-up. I wonder if that might be the case here, and what else was going on with the 90 y/o's health.

Sorry for the stress @SpineandWine, that sucks! Glad the family seems understanding.

VCFs that ended up being osteo? Did they not get MRIs?

 

[Marien klin]

Fungal meningitis after a kyphoplasty or injection is extremely rare and usually linked to contaminated steroids or surgical materials, as seen in the 2012 NECC outbreak. If sterile technique was followed and the patient wasn’t immunocompromised, it’s likely a coincidence rather than a procedural fault. Hospitals often limit details in such cases for legal reasons, but proper documentation and technique generally protect the doctor.

 

[MitchLevi]

SDN has bots driving our conversations or what?