Disclosures: Kishan A. Sitapara, MD: No financial relationships or conflicts of interest

Case Description: Clostridium difficile colitis (C. diff.) has been known to be caused by a wide array of medications. Commonly associated with antibiotics such as fluroquinolones, cephalosporins, and clindamycin as well as with exposure to the healthcare environment in general including hospitals and nursing homes. To this point however, C. diff. has not been associated with a sacrococcygeal joint injection.

Setting: Outpatient elective pain procedure

Patient: In this case, a 66 year old female had a right sided sacrococcygeal joint injection performed with fluoroscopic guidance, Isovue 240 contrast dye, a 3cc mixture of 1cc Triamcinolone acetonide 40mg/ml, and 2cc of 0.25% Bupivacaine. Assessment/

Results: After the procedure patient felt improvement in her pain however was noted to have abdominal pain 3 days after the procedure. Patient was subsequently hospitalized and treated for C. diff. and ultimately required a fecal transplant.

Discussion: Currently no literature exists showing any correlation between joint injections with Isovue, Triamcinolone acetonide, or Bupivacaine although given the temporal relationship between the procedure and our patient’s symptoms, further studies may be indicated. Given the number of procedures and injections in the pain community completed with similar medications it would be beneficial to be able to assess and enumerate the number of patients who develop C. diff. after similar procedures with comparable amounts and types of medications.

Conclusion: If there is a noted risk of contracting C diff. after similar procedures, it would need to impact the percentage of patients who would be deemed appropriate for such procedures moving forward.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sacrococcygeal-joint-injection-and-clostridium-difficile/