Nicolau’s syndrome induced by intramuscular vaccinations in children: report of seven patients and review of the literature

Abstract

Given the high prevalence of intramuscular injections during infancy, NiS seems to be a rare event, but there is a possibility of under-reporting of less severe reactions. Our retrospective data do not allow a true risk assessment. The most worrying aspect of NiS, however, is its lack of predictability. As long as complete avoidance of the intramuscular route is not an option, it is obvious that NiS cannot be completely prevented.

Best vaccination practice and medically attended injection site events following deltoid intramuscular injection

“…The syndrome has only been reported after vaccination in children and with one case reported 76 after intramuscular injection of Infanrix hexa Ò into the deltoid muscle of a 21 month old female.…”

Nicolau syndrome induced by intramuscular vitamin K in a premature newborn

“…NS is a clinical presentation of livedoid dermatitis that occurs after intramuscular injection [4,5]. With the first description of this syndrome by the use of bismuth salts for syphilis in 1925, several other drugs causing NS such as pyrazolone derivatives, diclofenac, vitamin B complex, streptomycin, lidocaine, phenobarbital, chlorpromazine, dexamethasone, triamcinolone, diphenhydramine and interferon alfa have been reported in time.…”

“…Nicolau syndrome (NS) or embolia cutis medicamentosa is a rare condition characterized by the acute onset of cutaneous and soft-tissue necrosis following the intramuscular injection of a given drug, and it is characterized by severe pain and erythematous ecchymotic reticular lesions at the injection site, which in many cases leads to necrotic ulcers and scarring [4,5]. Although severe anaphylactic/anaphylactoid reactions and local reactions are well-known adverse effects of fat-soluble vitamin K [1], there has been, to our knowledge, no reported neonatal NS associated with intramuscular administration of vitamin K.…”

Síndrome de Nicolau por la administración de la vacuna séxtuple intramuscular en un lactante de 6 meses

“…1 Dada la gran cantidad de dosis de vacunas administradas en forma intramuscular en los niños y los pocos casos reportados de este síndrome, se puede inferir que es un fenómeno de infrecuente aparición por la administración de vacunas. Se caracteriza por la aparición de un edema doloroso inmediato en el sitio de la inyección, que luego progresa a un eritema livedoide y a necrosis cutánea, que puede, incluso, comprometer el plano muscular.…”