A complicated infection post-pelvic floor botulinum neurotoxin type A injection for chronic myofascial pelvic pain: A case report
Bibliographic record
Abstract
Introduction: Botulinum neurotoxin A (BoNT-A) injections are increasingly used treatment for refractory myofascial pelvic pain. We report a complicated post-BoNT-A injection infection. Case description: A 27-year-old female patient with chronic myofascial pelvic pain presented for pelvic floor BoNT-A injection done in the operating room. Her past medical history was significant for ankylosing spondylitis being treated with Humira, daily smoking, and increased BMI. She presented to clinic 11 days later with progressively worsening left buttocks pain. On examination, she had a palpable indurated area with erythema on the left lower buttocks. She was admitted to hospital for pain management and IV antibiotics, initially Cefazolin and Metronidazole. CT scan showed an ischioanal collection. Antibiotic therapy was changed to Piperacillin/Tazobactam and Vancomycin. A percutaneous drain was placed on post-admission day 3 under ultrasound guidance which was removed 2 days later. An area concerning for necrosis was noted at the site of induration. The patient was taken to the OR for surgical debridement on post-admission day 7. She was discharged home on post-admission day 10 after transition to oral Amoxicillin/Clavulanate, which were continued for a total of 2 weeks. She was followed by the wound care team until resolution. Conclusion: BoNT-A injections are mostly performed on an outpatient basis in our clinical practice. Patients who undergo this procedure in the operating room are complexed and have risk factors predisposing them to infectious complication. They may require antibiotic prophylaxis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.008 | 0.005 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".