Accidental injection of EpiPen^® in right thumb of a healthy 10-year-old boy

Abstract

We report a case of accidental injection of adrenaline auto-injectors (EpiPen^®) in right thumb of a healthy 10-year-old boy. The boy went to play with an 8-year-old boyfriend who had been prescribed an EpiPen^®. The 8-year-old boy brought a backpack in which the EpiPen^® was put. The 10-year-old boy found the EpiPen^® in the backpack, and he took it out with interest. He misidentified it to be a “pen” for writing. When he removed its safety cap and pressed its needle cover, its needle accidentally stuck into his right thumb. He was not able to pull out the EpiPen^® for himself. After he got home, his mother removed the needle from his thumb and took him to our hospital one hour after the injection. During the examination, he had no tachycardia or hypertension. However, a part beneath the nail of his right thumb was pale. We followed-up without treatment. Seven hours after the accidental injection, the pale site was ameliorated ; 1 day after, the pale site disappeared, and the color became light blue. There were no complications, such as tissue necrosis and osteomyelitis. We assumed that EpiPen^® needle was stuck in his right thumb distal phalanx, and adrenaline affected the right dorsal finger artery causing vasoconstriction, leading to ischemia.