Multiple abscesses caused by repetitive intramuscular injections

A 52yearold man was referred to our hospital owing to fever of unknown origin lasting for 3 months. On examination, there was tenderness, swelling, and redness in both of his upper arms (Figure 1A). During a prior hospitalization, the patient had received as many as 250 intramuscular injections of hydroxyzine in his gluteus medius muscles and deltoid muscles bilaterally due to severe pain after an injury sustained in a traffic accident. Meropenem had been administered for 4 weeks in the previous hospital because of the fever of unknown origin. Blood cultures taken on the day of admission were negative. Computed tomography of his pelvis revealed bilateral cellulitis in his buttocks and abscess formation on his left side (Figure 2, arrows). Gdenhanced magnetic resonance imaging of his upper arms indicated the formation of a bilateral subcutaneous abscess 19 mm in diameter (Figure 3A,B, arrows). Antibiotics, including cefazolin and amoxicillin/ clavulanic acid, were administered for 6 weeks, and his symptoms improved (Figure 1B). Abscess formation must be recognized as a complication of inappropriate frequent intramuscular injections.1,2