Nicolau syndrome aggravated by cold application after i.m. diclofenac

Abstract

Nicolau syndrome is a rare but well-recognized cutaneous adverse drug reaction at the site of i.m. injection of certain drugs. Clinically, it is characterized by severe pain immediately after the injection followed by an erythematous reticular patch that may result in a necrotic ulcer and scarring at the injection site. We describe a 60-year-old woman with a painful, violaceous, crusted plaque after i.m. diclofenac administration to her right buttock. She had applied an ice pack to this area immediately after the injection to relieve the pain without any benefit. A clinical diagnosis of Nicolau syndrome due to diclofenac injection was made, and reconstructive surgery of the wound was performed. Although diclofenac is a widely used non-steroidal anti-inflammatory drug, Nicolau syndrome following i.m. diclofenac injection has rarely been reported in the published work. Application of a cold compress was considered an aggravating factor in our patient.

Late development Nicolau Syndrome: A case report

“…Despite the fact that the gluteus is more often the affected region, it has been also described as present in the shoulder, thigh, knee and ankle [5].…”

“…Nicolau Syndrome has already been described with the administration of many other drugs, such as benzathine penicillin, penicillin, non-steroid anti-inflammatories, local anesthetics, antihistamines, penicillin and glucocorticoids [5].…”

“…It is well described in dermatologic literature as a rare side effect characterized by livedoid dermatitis [3][4][5]7] which occurs after the intra-muscular injection of insoluble substances [4,[7][8][9] Nevertheless, the emergence of the Syndrome is associated with the route of administration and the new pharmaceutical formula of the drug, rather than with its pharmacodynamic properties, and consequently, there is not a specific group responsible for the complication potential. A systematic review showed that predisposing factors, such as watery micro-suspension in the vehicle, in opposition to oily, suggesting a prevalent genesis of the Syndrome's embolism [10] .…”

“…Nicolau Syndrome, or Embolia Cutis Medicamentosa, was first described by Juliusberg, Freudenthal and Nicolau between 1924 and 1928 [3][4][5][6]. The first descriptions refer to patients undergoing treatment for syphilis who received injections of bismuth salts.…”

Anticoagulant and vasodilator therapy for Nicolau syndrome following intramuscular benzathine penicillin injection in a 4 year old boy

“…[3][4][5][6][7] Anticoagulant and vasodilator therapy for Nicolau syndrome following intramuscular benzathine penicillin injection in a 4 year old boy…”