Gentimacin Injection Induced Digital Necrosis in a 32 -Year Old Apprentice: A Case Report

Alphonsus Udo

doi:10.4172/2327-4972.1000211

Abstract

Gentamicin is a type of aminoglycoside produced by the fermentation of bacteria widely present in the environment. Because of its widespread use and abuse, their toxic effects have become more obvious and sometimes bizarre. Toxic effects involve the kidneys, ears and rarely neuromuscular junction as well as neurovascular bundles leading to ischemia and tissue necrosis. I present a 32-year old apprentice who developed bluish to black discoloration of the terminal phalanx of the index, middle, ring and little fingers of both hands following several injections of gentamicin. Digital necrosis arising from injection of gentamicin is rare in the scientific literature. Adverse effects of aminoglycosides can be prevented through proper regulation of its use.

Highlights

Gentamicin is a type of aminoglycoside which is produced by the fermentation of micromonospora purpurea, a genus of gram-positive bacteria widely present in the environment [1,2]
The aminoglycosides are believed to act by binding to the 30s ribosomal subunit causing misreading of the mRNA codon, leading to errors in amino acid sequencing, disruption of polysomes, reducing the efficiency of protein synthesis, as well as inhibition of the translocation of tRNA between A and P ribosomal binding sites [4]
Tissue necrosis caused by intramuscular injection has been reported with phenylbutazone, local anaesthetics, corticosteroids and diclofenac but report of tissue necrosis following gentamicin injection is rare in the scientific literature [14,15]

Summary

Introduction

Gentamicin is a type of aminoglycoside which is produced by the fermentation of micromonospora purpurea, a genus of gram-positive bacteria widely present in the environment (water and soil) [1,2] It is composed of linked ring of amino sugars and amino substituted cyclic polyalcohol (aminocyclitol). I present an apprentice who developed necrosis of the terminal phalanx of the index, middle, ring and little fingers of both hands following multiple intravenous injections of gentamicin in a drug dispensing shop. Physical examination showed that he was in good condition and fairly well nourished but very anxious Both hands showed dark discoloration of the terminal phalanx of the index, middle, ring and index fingers. Urine analysis did not reveal any abnormality. (Please note that numbers in parenthesis represent normal reference values used in the hospital where the index patient presented for treatment)

Discussion

Conclusion