Azithromycin Extravasation in a Pediatric Patient

Abstract

Objective:

To report a case of azithromycin infiltration and extravasation in a pediatric patient.

Case Summary:

A 12-month-old African American male, between chemotherapy cycles for acute myelogenous leukemia, self-dislodged his central venous catheter. A peripheral catheter was placed in the right dorsal hand and, 2 days later, azithromycin for injection infiltrated at the infusion site. Several bullae formed in the first web space and a few areas of epidermolysis, each <2 cm wide, later appeared on the forearm. Treatment included warm compresses, adaptee dressing, topical antibiotics, splint placement, and arm elevation. Four months after the incident, there was no visible impairment or restriction to the toddler's use of the right hand or arm. The only residual finding was an area of hypopigmented skin in the dorsal web between the first and second fingers.

Discussion:

As of February 10, 2005, this is the first case published in the English-language literature describing intravenous azithromycin infiltration and extravasation. Infiltration occurs generally by 3 mechanisms. These include the catheter dislodging or causing a hole in the vessel wall, intravenous fluid irritating the vessel wall leading it to rupture or leak, or backflow of intravenous fluid through the catheter insertion site.

Conclusions:

Complications can occur secondary to intravascular therapy, including extravascular extravasation. In this case, infiltration and extravasation injury were probably related to azithromycin. Immediate detection and treatment are critical to decrease morbidity associated with infiltration events.