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Spinal cord infarction (SCI) is extremely rare in children, and only 2 other reports have described the occurrence of SCI in patients with hemoglobin SC disease (HbSC). Amusement park accidents are serious injuries. Patients with preexisting conditions, such as hypertension, cardiac disease, and recent back or neck injuries, may be at an increased risk. We report the case of a 12-year-old girl with HbSC with a past history of only 2 admissions for pain crises, who presented to the emergency department with symptoms of SCI after riding a roller coaster. Fibrocartilaginous embolism (FCE) is an increasingly recognized cause of SCI after events that put strain on the axial skeleton, such as many amusement park rides. Although radiologic criteria for FCE have been proposed, FCE remains a diagnosis of exclusion. To the best of our knowledge, this is the first documented case of SCI in a patient with HbSC and the first case of FCE after an amusement park accident. This case report highlights that HbSC may confound the differential diagnosis of SCI and aims to document an association with FCE in pediatric patients.

RATIONALE: About 10% of patients report allergy to penicillin. Of those patients evaluated with a penicillin skin test (ST) and challenge, 90-99% are able to tolerate penicillin, resulting in penicillin allergy de-labeling. However, while patients are often de-labeled in the short term, factors that predict the persistence of penicillin allergy de-labeling remain unknown. METHODS: A retrospective chart review was conducted on patients evaluated for penicillin allergy from 2012-2017(inpatient and outpatient). Data was collected from the electronic medical record (EMR), pharmacy records, as well as a follow-up telephone survey with patients. RESULTS: Thirty-three patients were successfully de-labeled of their penicillin allergy (negative ST and tolerated oral challenge). One-third of these patients had persistence of their penicillin allergy in the EMR (11/ 33), and 7 patients had persistence in their pharmacy records (21%). Persistence of the penicillin allergy label was not significantly associated with age (p50.73), gender (p50.35), or whether the evaluation was done inpatient or outpatient (p50.88). Follow-up telephone survey was done with 24 patients (nine patients were unavailable for follow-up), and 96% (n523) recalled the results of their allergy evaluation correctly. Despite accurate recall, 3 patients continued to avoid penicillin for fear of a possible reaction. CONCLUSIONS: This study found that while penicillin allergy delabeling is safe and effective, there is a discrepancy between the allergy evaluation and the appropriate removal of the penicillin allergy from the EMR and pharmacy records, which may include patient apprehension as a cause. Neither age, gender, nor place of evaluation predicted persistence of the penicillin allergy label.