Case Report: Nicolau syndrome due to etofenamate injection

Abstract

Nicolau syndrome, also known as embolia cutis medicomentosa, is a rare complication characterized by tissue necrosis that occurs after injection of drugs. The exact pathogenesis is uncertain, but there are several hypotheses, including direct damage to the end artery and cytotoxic effects of the drug. Severe pain in the immediate postinjection period and purplish discoloration of the skin with reticulate pigmentary pattern is characteristic of this syndrome. Diagnosis is mainly clinical and there is no standard treatment for the disease. Etofenamate is a non-steroidal anti-inflammatory drug and a non-selective cyclooxygenase inhibitor. Cutaneous adverse findings caused by etofenamate are uncommon. Herein, we present a case with diagnosis of Nicolau syndrome due to etofenamate injection, which is a rare occurrence.

Nicolau syndrome caused by non‐steroidal anti‐inflammatory drugs: Systematic literature review

“…The chance‐adjusted agreement between the two investigators on the application of the inclusion and exclusion criteria was 0.88. A total of 45 eligible reports 6‐50 published between 1996 and 2019 in English (N = 44) or Spanish (N = 1) were identified. The reports were primarily (N = 41, 91%) from Europe (Turkey, N = 17; Italy, N = 4; Belgium, N = 1; Germany, N = 1; Switzerland, N = 1) and Asia (India, N = 9; South Korea, N = 5; China, N = 1; Israel, N = 1; Qatar, N = 1).…”

“…The aforementioned 45 reports included 62 previously healthy subjects (40 females and 22 males aged from 13 to 81, median 57 years) with Nicolau syndrome occurring after intramuscular 6‐11,13‐50 or local 12 injection of a non‐steroidal anti‐inflammatory drug, as shown in Table 1. The vast majority of cases (N = 53; 85%) occurred following administration of diclofenac.…”

Atípusos haemorrhagiás bőrtünetek hátterében igazolt hajas sejtes leukaemia poliszenzibilizált betegen

“…Az etofenamát -2-(2-hidroxi-etoxi)etil-N-(α,α,α-trifluorm-tolil)antranilát -egy nemszelektív ciklooxigenáz (COX)-inhibitor, erősen lipofil antranilsav-származék, helyi gyulladásgátlóként az 1970-es évek óta alkalmazzák [4][5][6][7]. Analgetikus, antireumatikus, antipiretikus és antiinflammatorikus hatását a prosztaglandinszintézis gátlásán keresztül fejti ki, de NSAID-ként ismert a lokális vasospasmust és cirkulációt befolyásoló hatása is [4,[8][9][10][11][12]. Bár a készítmény alkalmazásával kapcsolatos adverz reakció előfordulása viszonylag ritka [13], egy nemrégiben publikált tanulmány szerint az NSAID-ok vonatkozásában a ketoprofén és a dexketoprofén után az etofenamát a leggyakoribb fotoallergén [3].…”

Nicolau syndrome following intramuscular benzathine penicillin injection: a case report

“…Nicolau Syndrome (NS) is a rare livedo-like dermatitis which is a complication caused by intramuscular injection of various medication [ 1 ]. It is also known as embolia cutis medicamentosa [ 2 ].…”