Ischémie aiguë de membre sévère sanctionnée par désarticulation de sauvetage dans un contexte de syndrome de Nicolau suite à une injection intramusculaire de pénicilline

Tougouma, Somnoma Jean-Baptiste; Soulama, Massadiami; Konaté, Issouf; Tapsoba, Emmanuel; Yaméogo, Nobila Valentin; Dakouré, Patrick Wendpouiré Hamed

doi:10.11604/pamj.2020.37.378.21384

Cited by 3 publications

(3 citation statements)

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“…5 As illustrated in a case report published in 2020 by Tougouma et al, even the standard of care of intramuscular penicillin injections demonstrates devastating aftermath if not approached with caution. 2 In another case report, a 5-year old patient received an intramuscular injection of penicillin that developed into a bullae at the injection site, progressed to necrotic lesions and ultimately resulted in an above knee amputation. 6 Marcus et al published a case report in 2019 which further conveys the danger of intramuscular injections; a 21-year old patient required administration of penicillin intramuscular injection for the management of a sexually transmitted infection.…”

Section: Hypotheses For This Syndromementioning

confidence: 99%

“…This skin blanching progresses to a violaceous livedoid dermatitis; which proceeds into a hemorrhagic bullae followed by a necrotic ulceration. 1,2 The necrotic ulceration may be a nidus for infection, further ischemia or may even progress to an amputation. 2 A variety of theories have been proposed in regards to the pathophysiology of this disease, however, the current consensus appears to be that NS develops from vascular occlusion due to the trauma of the injection and/or the crystallization of the drug within the blood vessel(s).…”

Section: Introductionmentioning

confidence: 99%

“…1,2 The necrotic ulceration may be a nidus for infection, further ischemia or may even progress to an amputation. 2 A variety of theories have been proposed in regards to the pathophysiology of this disease, however, the current consensus appears to be that NS develops from vascular occlusion due to the trauma of the injection and/or the crystallization of the drug within the blood vessel(s). 3 Our aim is to educate our colleagues on the life-altering pathology of Nicolau Syndrome, an associated complication of intramuscular injections.…”

Section: Introductionmentioning

confidence: 99%

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Nicolau syndrome, embolia cutis medicamentosa, an iatrogenic consequence of intramuscular injections: a case report and literature review with a synthesis of case studies

Nasser,

Saad,

Saracco

2024

MOJCR

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Introduction: Nicolau syndrome (NS) was first described in 1924 by Freudental and Nicolau in a syphilis patient that was treated with injections of bismuth. NS is characterized by skin necrosis secondary to vascular occlusion caused by intramuscular drug injections. Recent literature has shown that livedoid dermatitis and embolia cutis medicamentosa are symptoms of Nicolau syndrome, which develop into a hemorrhagic bullae. The bullae then progress to necrotic ulcerations that may lead to infection, ischemia and even limb loss.Purpose: To describe Nicolau Syndrome and the life-altering effects it can have on patients.Methodology & procedure: A systematic review of studies published in the Medline database from January 2018 through July 2022 was conducted to identify articles that evaluated the causes and symptoms of Nicolau Syndrome. The systematic review was conducted following the PRISMA guidelines with an inclusion criteria of Nicolau syndrome diagnosis with no exclusion criteria. Summary tables were generated from the included studies for case specific indications of the intramuscular injection(s), sequence of symptomology, any treatment(s) administered and outcome of the syndrome for each case.Results: 36 Cases of NS were reported in the last 5 years from our literature search. The PRISMA flow diagram will show the reported cases, sex, age, what the injection consisted of, the number of recorded injections in the past 3 and 5 years and treatments (if rendered) with outcomes, if data is available. Spontaneous resolution was seen in a few select cases, although most ended up with some type of debridement/amputation. Case description:Our patient was a 47-year-old female with a long history of corticosteroid injections including the neck, back and upper extremities, with her most recent injection for plantar fasciitis of her left foot. After the injection she was prescribed oral Cephalexin that she took for two days before presenting to the emergency department with a small lesion that had dermatological changes consistent with bruising/contusion. Over the course of the month, the patient's lesion continued to deteriorate despite several treatment attempts from a multidisciplinary limb salvage team. Ultimately, she underwent a left lower extremity below-knee amputation.Discussion: Use of intramuscular injections across all fields of medicine is commonplace and it would appear physicians overlook or are unaware of the risks of Nicolau Syndrome. Although the pathogenesis is still debated, researchers have theorized that sympathetic activation results in vasoconstriction, embolic occlusion of microcirculation, and prostaglandin synthesis inhibition.

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Section: Hypotheses For This Syndromementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nicolau syndrome, embolia cutis medicamentosa, an iatrogenic consequence of intramuscular injections: a case report and literature review with a synthesis of case studies

Nasser,

Saad,

Saracco

2024

MOJCR

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Benzathine-benzylpenicillin

2021

Reactions Weekly

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Hypertonic Activity of Injection Solutions Can Cause Post-injection Complications (Review)

Ураков

Уракова

Shubina

et al. 2023

Razrabotka i registraciâ lekarstvennyh sredstv

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Introduction. A review of the scientific literature showed that the current standards for assessing the quality of drugs does not include an assessment of the osmotic activity of drug solutions and their local irritant effect on tissues at the sites of subcutaneous, intramuscular and intravenous injections. Therefore, currently injectable solutions considered to be of high quality may not have isotonic activity and high postinjection safety.Text. A study of the concentration range of quality drug solutions ready for injection showed that the acceptable concentration value of the main ingredients is in the range of 0.01 to 76 %. Direct measurement with an osmometer of the osmotic activity of injection solutions, considered qualitative today, has shown that injection solutions can have hypotonic, isotonic and hypertonic activity and their osmotic activity can be in the range of 0 – 3900 mosmol/l water. Study of acidic activity of drug solutions showed that in accordance with pharmacopoeial requirements of drug quality modern quality drug solutions ready for injection can have acidic, neutral or alkaline activity. Solutions with hypertonic activity have been found to have a local irritant effect. Moreover, an increase in hypertonic activity of drug solutions increases their local irritant effect. It has been found that excessively high hypertonic activity of drug solutions may be the cause of the development of a local postinjection complication known as "Nicolaou syndrome", the cause of which has remained unknown for a long time. Nicolaou syndrome includes local pain syndrome, aseptic inflammation, necrosis, and abscess.Conclusion. The authors conducted a literature review, the results of which led to conclusions and assumptions. Solutions containing drugs in concentrations greater than 10 % may have the highest hypertonic activity, which can cause excessive dehydrating, local irritating and cauterizing effects. Therefore, injections of such drugs are most dangerous with the development of post-injection necroses and abscesses. That is why timely dilution of concentrated drug solutions with water by 2–10 times increases injection safety. It is proposed to include the assessment of osmotic activity and local irritant effect of drug solutions in the standard of drug quality control.

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Ischémie aiguë de membre sévère sanctionnée par désarticulation de sauvetage dans un contexte de syndrome de Nicolau suite à une injection intramusculaire de pénicilline

Cited by 3 publications

References 5 publications

Nicolau syndrome, embolia cutis medicamentosa, an iatrogenic consequence of intramuscular injections: a case report and literature review with a synthesis of case studies

Nicolau syndrome, embolia cutis medicamentosa, an iatrogenic consequence of intramuscular injections: a case report and literature review with a synthesis of case studies

Benzathine-benzylpenicillin

Hypertonic Activity of Injection Solutions Can Cause Post-injection Complications (Review)

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