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and opiates and NSAIDs to control his pain. Routine cultures of Rybinski’s blood and spinal fluid showed no bacteria, but the drug treatment eased his symptoms and he was discharged (18). Despite continuing his antibiotic treatment at home, Rybinski’s headache and back pain worsened (18). A week after his discharge, he returned to Vanderbilt and was obviously ill, uncomfortable, and A sample of Aspergillus fumigatus in the Vanderbilt Clinical Microbiology Lab for patient care agitated. His speech was incomprehensible. evidence that steroid injections are useful in easing The analysis of a new spinal tap was still consistent straightforward chronic low back pain (1, 19). with meningitis, but now an MRI revealed brain Despite the weak evidence, the use of steroid inflammation. Intravenous antibiotics improved his injections to treat back pain has skyrocketed in the mental state over the next two days (18). last 15 years, much more rapidly than the number Unfortunately, by his sixth day in the hospital, of patients with back pain or the aging of the Rybinski was increasingly drowsy, he stared population (1, 19). Some patients receive more than intermittently, and the right side of his face drooped. 10 shots per year (19). A brain scan showed mild hydrocephalus (18). NECC had been shipping its drugs to the St. Pettit’s team began to suspect that Rybinski’s Thomas Center for about a year when Rybinski meningitis symptoms might stem from a far rarer arrived for his steroid treatment. His injection fungal infection, and they began treatment with the came from a 12.5 l batch of methylprednisolone antifungal agent, amphotericin B (17, 18, 20). acetate that NECC had manufactured two months The following day, Vanderbilt’s microbiology lab earlier (17). It was labeled as a sterile solution, confirmed the diagnosis. A culture of the spinal but unlike the vials produced by Pfizer and other fluid that had been drawn on the day Rybinski was drug manufacturers, NECC’s solutions were re-admitted to the hospital showed Aspergillus preservative-free (9). Even more troublesome, fumigatus (18). The doctors began intravenous NECC’s compounding pharmacists had sidestepped voriconazole and continued treatment with liposomal batch testing that would have ensured the amphotericin B. An MRI revealed newly damaged methylprednisolone solution was sterile (17), blood vessels in his brain (18). A month later, Rybinski went to the Vanderbilt University Medical Center in Nashville, complaining Sleuthing the Cause of headache, neck pain, nausea, fatigue, and Unlike bacterial meningitis, fungal meningitis is decreased appetite (18). Based on blood tests, a not contagious (21). Petitt’s team investigated the spinal tap, and a CAT scan, April Pettit and her team possible source of Rybinski’s infection. Aspergillus diagnosed meningitis (17, 18). The most common species are ubiquitous in the air, soil, and organic cause of meningitis is a bacterial infection, and matter. The fungus typically enters the body through Pettit’s team prescribed antibiotics for the infection the sinuses, lungs, or a break in the skin, but it rarely

Reprinted from The Pharmacologist • June 2017

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2018 Special Compilation Issue of The Pharmacologist  

ASPET is pleased to present the second in a series of special editions of our quarterly news magazine, The Pharmacologist. This special com...

2018 Special Compilation Issue of The Pharmacologist  

ASPET is pleased to present the second in a series of special editions of our quarterly news magazine, The Pharmacologist. This special com...