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BMJ Case Rep. 2015 Dec 11;2015. pii: bcr2015212110. doi: 10.1136/bcr-2015-212110.

Atlanto-axial infection after acupuncture.

Author information

Department of Medicine, Geraldton Regional Hospital, Geraldton, Western Australia, Australia.
University of Western Australia, Perth, Australia Neurosurgical Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia.
Department of Medicine, Geraldton Regional Hospital, Geraldton, Western Australia, Australia University of Western Australia, Perth, Australia.


A 67-year-old man presented with neck cellulitis following acupuncture for cervical spondylosis. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Increased neck pain and bacteraemia prompted MRI, which showed atlanto-axial septic arthritis without signs of infection of the tissues between the superficial cellulitic area and the atlanto-axial joint, thus making direct extension of infection unlikely. It is more likely that haematogenous spread of infection resulted in seeding in the atlanto-axial joint, with the proximity of the arthritis and acupuncture site being coincidental. Acupuncture is a treatment option for some indolent pain conditions. As such, acupuncture services are likely to be more frequently utilised. A history of acupuncture is rarely requested by the admitting doctor and seldom offered voluntarily by the patient, especially where the site of infection due to haematogenous spread is distant from the needling location. Awareness of infectious complications following acupuncture can reduce morbidity through early intervention.

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