Fungal Meningitis – Is This a Risk from Steroid Injections In Dermatology?

Corticosteroid (CS) injections of various types have been used to treat a variety of dermatological diseases.

You could receive injections of CS intramuscularly (IM) to treat widespread cases of eczema or allergic skin rashes.

On some occasions you could receive intralesional (IL) CS injections to deliver a high concentration of medication to a specific area.  These localized IL injections are oftentimes used to treat acne nodules and cysts, psoriasis, keloid scars, alopecia or  other hair and scalp conditions as well as many more dermatological diseases.

The medications that dermatologists use most commonly for these types of treatments include the following:

1. 1. Dexamethasone Phosphate 4mg/ml
   2. Kenalog 10mg/ml or 40mg/ml (Triamcinolone Acetonide)
   3. Diluted concentrations of Kenalog 2mg/ml, 3mg/ml, or 5mg/ml
   4.   Celestone Soluspan
   5. Aristocort 40mg/ml (Triamcinolone Diacetate)

These types of steroid medications differ specifically from the drug that has been associated with the majority of the fungal meningitis outbreak?

Methylprednisolone produced at the New England Compounding Pharmacy in Framington, Massachusetts is the product that has been specifically associated with the fungal infections in the two hundred plus cases that have occurred.

In the latest reports, 2 additional cases have developed due to the injection of triamcinolone acetonide compounded and prepared at the same facility. This is a generic version of the Kenalog medication mentioned above.

So far, the spinal tap has been the route of injection for all of the cases of meningitis related fungal infections that have developed. As part of the treatment for back pain, the medication is injected directly into the spinal fluid which has a direct connection with the cerebral fluid that usually flows through and protects the brain. In these cases, the fluid provides the fungal organisms with a direct path to being able to infect the lining surfaces of the brain (meninges).

So, since dermatologists don’t usually administer medications by spinal tap and methylprednisolone is rarely if ever used for injections of any type in dermatology, the risk of developing fungal meningitis from steroid injections to treat the skin should be non-existent.

However, since the new reports show that 2 cases have developed due to triamcinolone acetonide which is a generic equivalent of Kenalog, the risk of skin infection could be present if the medication manufactured by the New England Compounding Center with a fungal presence was used to inject the skin.  To date, no reports of any skin infections of this type are known to exist.

Also, at this time, all of the products produced by the New England Compounding Center have been recalled and no new batches have been released so it is highly unlikely that any physician will be administering injections with these products ever again.

So, you should be able to feel secure that any steroid injection done by your dermatologist whether they are intralesional or intramuscular should have no risk of causing fungal meningitis.