Case report. The pathogenesis of neurovascular complications following penicillin injection

A 12-year-old patient presented following inadvertent intraarterial injection of benzathine penicillin. Complications manifested as an incomplete cauda equina lesion with ischaemia and necrosis over the buttock in the distribution of the injected artery. Angiography confirmed damage to the superior gluteal artery while histology revealed severe ischaemic damage without evidence of an allergic process. Spasm of the injected vessel with retrograde flow and occlusion by particulate matter can explain the clinical manifestations. The prognosis for these complications is poor and the best approach lies in prevention.