Leg cellulitis after Kenalog injection for shoulder

[CarabinerSD]

I have a patient whom I've been doing shoulder joint cortisone injections with good relief. The problem is when we use Kenalog 40mg (from multi dose vial) she would develop BLE erythema/ cellulitis going up to her knee (consistently x2 now, and I've seen the pictures) which required abx treatment. For this 3rd round, I used Dexamethasone 10mg (preservative free, single dose) instead and it only lasted a few days for her (but no BLE erythema). The injection is fluoroscopic guided (omnipaque 240, Lidocaine 1%) in all instances for guidance. The only thing that differed was the steroid used.

Has anyone seen leg erythema or cellulitis flare up with Kenalog (Multi dose vial)? Any recommendations on what to do from here since her relief was much shorter w/ Dexamethasone...maybe try Celestone?

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[SSdoc33]

I have a patient whom I've been doing shoulder joint cortisone injections with good relief. The problem is when we use Kenalog 40mg (from multi dose vial) she would develop BLE erythema/ cellulitis going up to her knee (consistently x2 now, and I've seen the pictures) which required abx treatment. For this 3rd round, I used Dexamethasone 10mg (preservative free, single dose) instead and it only lasted a few days for her (but no BLE erythema). The injection is fluoroscopic guided (omnipaque 240, Lidocaine 1%) in all instances for guidance. The only thing that differed was the steroid used.

Has anyone seen leg erythema or cellulitis flare up with Kenalog (Multi dose vial)? Any recommendations on what to do from here since her relief was much shorter w/ Dexamethasone...maybe try Celestone?

this is an allergic rxn to the kenalog, not cellulitis. cant image abx help --would probably go away anyway. dont use kenalog

 

[manowar rules]

this is an allergic rxn to the kenalog, not cellulitis. cant image abx help --would probably go away anyway. dont use kenalog

What’s wrong with kenalog? Definitely the mainstay steroid in our ortho and pain clinic

 

[buddababa]

What’s wrong with kenalog? Definitely the mainstay steroid in our ortho and pain clinic

Because FDA Epidural and intrathecal administration of this product is not recommended.

Using in joints up to you

 

[SSdoc33]

What’s wrong with kenalog? Definitely the mainstay steroid in our ortho and pain clinic

Don’t use kenalog for THIS patient. Otherwise, bombs away

 

[clubdeac]

Try depo 40mg and see if it happens

 

[joshmir]

OP, what do you think of the possibility that the kenalog is getting absorbed systematically and resulting in lower extremity edema due to its systemic steroid effect on fluid retention dynamics?

 

[CarabinerSD]

OP, what do you think of the possibility that the kenalog is getting absorbed systematically and resulting in lower extremity edema due to its systemic steroid effect on fluid retention dynamics?

The pictures she showed me looked like cellulitis with demarcated erythema. There was no edema or waxy appearance to suggest fluid retention.

Regardless I'll be switching away from Kenalog for this one patient, maybe try Depo as someone else suggested.

 

[$hadow]

this is an allergic rxn to the kenalog, not cellulitis. cant image abx help --would probably go away anyway. dont use kenalog

After doing a little bit of research, I agree, sounds like an allergy causing wide spread reaction, likely due to the preservative’s in the drug (like benzyl alcohol) which also makes sense because he used dexamethasone without any preservatives and there was no issue?

The likelihood of developing back to back cellulitis or erysipelas (because of the well defined demarcated borders) which is wide spread is very low if I’m not mistaken.

As far as I’m aware you can get preservative free versions of long acting steroids like Triamcinolone acetonide (Kenalog) and Methylprednisolone acetate (Depo-Medrol); but I would likely try the latter to be on the safe side.

P.S - I have not graduated medical school yet, so this is based off research only, but it was an interesting case, and wanted to contribute what I found.