Nicolau syndrome caused by piroxicam

“…Several drugs have been reported to cause necrosis, such as local anesthesia [1], antihistamine (promethazine) [1], vitamin B complexes [1], diclofenac sodium [2-4], ketoprofen [2], piroxicam [4], corticosteroids [5], diphtheria, tetanus, pertussis vaccine [6], and meperidine [1]. …”

Section: Discussionmentioning

confidence: 99%

Nicolau Syndrome after Intramuscular Injection: 3 Cases

Kim

Lee

2012

Arch Plast Surg

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Nicolau syndrome is a rare complication of intramuscular injection consisting of ischemic necrosis of skin, soft tissue, and muscular tissue that arises locoregionally. The characteristic pattern is pain around the injection site, developing into erythema, a livedoid dermatitis patch, and necrosis of the skin, subcutaneous fat, and muscle tissue. Three patients were injected with drugs (diclofenac sodium, ketoprofen, meperidine) for pain relief. Three patients complained of pain, and a skin lesion was observed, after which necrosis developed on their buttocks. Each patient underwent debridement and coverage. The wound healed uneventfully. We report three cases of Nicolau syndrome in the buttocks following diclofenac intramuscular injection.

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“…The necrosis often involves the muscles, and secondary bacterial infection may occur. Although the buttocks are the most frequent site, NS also has been reported on the shoulder, 2 thigh, 10 knee 2 and ankle 11 . Most published reports are on adults; only four children 8,12 and one infant 10 with NS have been reported in the English published work.…”

Section: Discussionmentioning

confidence: 99%

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

Şenel¹,

Ada²,

Güleç³

et al. 2007

The Journal of Dermatology

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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.

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Nicolau syndrome caused by piroxicam

Cited by 28 publications

References 4 publications

Nicolau syndrome as an avoidable complication

Nicolau syndrome as an avoidable complication

Nicolau Syndrome after Intramuscular Injection: 3 Cases

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

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