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A severe adverse reaction, potentially injection-site related, caused acute limb symptoms in a young man. Prompt medical evaluation ruled out vascular compromise, suggesting a localized inflammatory or allergic response.

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Area of Science:

  • Vascular Surgery
  • Pharmacology
  • Emergency Medicine

Background:

  • A 23-year-old male presented with acute left lower limb pain, edema, and mottling.
  • Symptoms began shortly after receiving intramuscular penicillin 6.3.3 injections.
  • Initial symptoms included burning and discoloration at the injection site, rapidly progressing distally.

Observation:

  • The patient experienced severe pain, significant edema, and muscle spasm within 30 minutes of the third penicillin injection.
  • Mottling of the foot's dorsal and plantar aspects was noted.
  • Symptoms persisted for 36 hours before hospital admission.

Findings:

  • Color Doppler sonography demonstrated normal arterial flow throughout the left lower extremity.
  • Major arteries including the common femoral, superficial femoral, popliteal, dorsalis pedis, and posterior tibialis arteries showed no abnormalities.
  • Superficial probe sonography revealed mild ankle effusion without evidence of abscess collection.

Implications:

  • The clinical presentation suggests a severe localized reaction to the intramuscular penicillin injection, possibly an acute inflammatory or hypersensitivity response.
  • The absence of vascular impairment on Doppler sonography is crucial for diagnosis and management planning.
  • This case highlights the importance of considering injection-related complications in acute limb presentations, even with normal vascular imaging.