[Erythema and fever after diclofenac i.m]

We describe a patient with a streptococcal myositis/fasciitis and toxic shock syndrome following an intramuscular injection with diclofenac. A patient complaining of sore throat and headaches for two days and fever up to 38.5 degrees C for one day consulted her family physician. 75 mg of diclofenac were injected intramuscularly for symptomatic treatment. On the next day massive pain at the injection site and a generalized erythema occurs and fever up to 38.5 degrees C persists. She is admitted to the local hospital for suspected abscess formation. Despite rapid antibiotic treatment a septic shock develops. The patient is transferred to a tertiary care hospital. An extensive debridement is performed and the antibiotic regimen changed to high dose penicillin and clindamycin. The association of life threatening diseases due to Group A streptococci and non-steroidal anti-inflammatory drugs (NSAID) is well documented by several case reports. We believe there is no longer any need for intramuscular injections of NSAID. The rare but severe complications preclude further use of the intramuscular dosage in view of the availability of oral alternatives.