A case of Nicolau syndrome (NS) in a 36-year-old adult taking an unusual and devastating hyperacute irreversible paraplegia after an intramuscular injection of benzathine penicillin as a part of routine chemoprophylaxis of her rheumatic heart disease is reported. Although this syndrome is a considerably rare, iatrogenic and underappreciated dermatologic entity, we reiterate in this report, its extracutaneous systemic potential for a catastrophic neurovascular phenomenon and morbidity as well as its possible preventive measures. The apoplectiform onset of T10 flaccid areflexic paraplegia, with the cutaneous hallmark of “embolia cutis medicamentosa” was corroborated by magnetic resonance imaging evidence of centromedullary complete cord involvement from T10 to conus medullaris. Combination therapy with pulse methylprednisolone, low-molecular-weight heparin, and pentoxifylline infusion proved unsuccessful. The skin biopsy and direct immunofluorescence revealed features were consistent with NS with overlap features of leukocytoclastic vasculitis, hitherto not reported. The literature of this preventable and iatrogenic disorder is reviewed, and plausible etiology is discussed.
This case report describes the very rarest possibility of drug induced hyperkalemia with beta blockers. In literature search only 2 cases were reported as metoprolol succinate induced hyperkalemia in diabetes patients without renal insufficiency. As per FDA reports only 0.5 % patients have reported hyperkalemia induced by metoprolol [1]. Patient is diabetic and hypertensive. And she is on oral hypoglycemic agents, premixed insulin and on beta blockers along with calcium channel blocker. The potassium value was ranging from 6 to 6.7 mmol/l. Evaluated in detail and no other abnormalities noted in laboratory investigations. Once the offending drug metoprolol is withdrawn the potassium value reaches to normal range in very short period.
Imidacloprid is a neonicotinoid systemic insecticide. It is used to control agricultural pests. It controls the insects from within the plant. This product is applied to the soil and is taken up by the roots. Imidacloprid belongs to a new chemical family of chloronicotinyl compounds. Its mode of action on the insect nervous system differs from that of a traditional neurotoxic product. This compound is considered relatively safer to human beings, but it can lead to potentially life-threatening complications. Large quantity of this compound when ingested causes fatal complications like respiratory failure, cardiac arrythemias. We reported a case of imidacloprid poisoning with its rarest unreported complications.
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