Acupuncture – A Pain Reliever or Source of Infection?

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A 67-year-old male with neck pain used to get acupuncture to relieve his pain. However, once he developed cellulitis at the acupuncture site!

Acupuncture is a technique of alternative medicine that involves inserting fine, thin needles at specific points of the body. It is an age-old Chinese traditional healing technique. Once confined to the Chinese territory, its fame gradually crossed the borders. Therefore, in recent times, acupuncture is a part and parcel of many individual’s lives. However, the risk of infection associated with acupuncture should not be overlooked. Although complications are rare, these carry a high rate of morbidity and mortality.

Here is a case report of infection secondary to acupuncture:

A 67-year-old male presented to the emergency department with complaints of malaise and low-grade fever. Moreover, he complained of feeling generally unwell with a history of progressively worsening neck pain. Upon inquiring, the patient told the doctors that acupuncture helps him with the pain of cervical spondylosis, therefore, he recently completed another 5-week acupuncture course.

Additionally, the patient had a history of chronic obstructive pulmonary disease (COPD), osteoarthritis, and post-traumatic stress disorder. He was allergic to penicillin as he probably developed angioedema on past exposure to penicillin.

The patient was a smoker and continued smoking despite the diagnosis of COPD.

The patient was not using steroids or any immunosuppressive medications. Nor he had a history of illicit drug abuse.

Examination revealed a febrile and tachycardic male of average height and built. The rest of the vitals were normal. Respiratory examination and CXR were consistent with COPD. There was no active chest infection.

The doctors noticed a 30×40 mm area of cellulitis on the posterior aspect of his neck (at the site of acupuncture). They also noticed a decreased range of motion of the neck. Since the patient also had cervical spondylosis, the change in the ROM was difficult to be assessed. The patient had no signs of meningism. The rest of the examination was normal.

Serology revealed a white cell count of 14.10×109 (neutrophilia of 85.5%, absolute value 12.1×109/L). C reactive protein was elevated at 258 mg/L.

Blood cultures grew methicillin-sensitive Staphylococcus aureus.

Transthoracic echocardiogram ruled out endocarditis. Gadolinium-enhanced cervical MRI confirmed septic arthritis of the atlantoaxial joint.

Flexion-extension cervical spine X-rays showed no dynamic instability. The neurosurgical team advised a surgical procedure. However, they did not recommend any specific immobilisation.

During the patient’s 8-day hospital stay, he received intravenous vancomycin and intravenous cephazolin for 6 weeks.

At the 6-week-follow-up, the white cell count improved to 7.80×109/L and C reactive protein reduced to 10 mg/L. Besides, the patient showed substantial clinical improvement.

Post-treatment MRI revealed mild sclerosis at the articular surfaces of the atlanto-dens articulation, with features suggesting healing arthritis.

A- MRI image showing features suggesting septic arthritis of the atlantoaxial joint B- Post-treatment MRI

Reference: Robinson A, Lind CR, Smith RJ, Kodali V. Atlanto-axial infection after acupuncture. BMJ Case Rep. 2015;2015:bcr2015212110. Published 2015 Dec 11. doi:10.1136/bcr-2015-212110

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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