A young woman who developed a bone infection, rather than meningitis, is the 13th Minnesotan to fall ill from contaminated steroid injections produced by a Massachusetts pharmacy, state health officials reported Thursday.

The woman, who is in her 20s, had tested negative for meningitis several weeks ago, said Dr. Aaron DeVries of the Minnesota Department of Health. But follow-up tests found that she had developed a bone infection in her back, where she received the injection.

The case prompted the Health Department to issue a release Thursday saying that patients who received shots of the contaminated steroids should be on the alert for pain around the injection sites, and may require imaging tests such as MRIs, even if they haven't tested positive for meningitis.

"We wanted clinicians and patients to know that these complications have been detected in some of the patients," said Dr. Ruth Lynfield, the Minnesota state epidemiologist, who is heading the department's investigation into the outbreak.

"In some of the individuals, the symptoms were not very dramatic, so there needs to be a very low threshold for evaluating patients."

The woman, who was not identified, is one of nearly 1,000 Minnesotans who received steroid shots from contaminated lots that have been linked to a nationwide meningitis outbreak. The steroids were produced by the New England Compounding Center in Framingham, Mass., which is now shut down and under federal investigation.

The woman is being treated for the fungal infection, but is not hospitalized, health officials said.

She is the second of the 13 confirmed cases in Minnesota to be diagnosed with a bone infection rather than meningitis.

Nationwide, 461 people have developed meningitis and 10 have reported joint infections linked to the tainted steroids. The outbreak has resulted in 32 deaths. This week two congressional committees began hearings into the outbreak.

In Minnesota, the steroids were administered by two clinic groups, Medical Advanced Pain Specialists and the Minnesota Surgery Center, but state officials later learned that dozens of other clinics and hospitals acquired other medications from the Massachusetts pharmacy.

Maura Lerner • 612-673-7384