Nicolau syndrome induced by intramuscular vitamin K in a premature newborn

Köklü, Esad; Sarıcı, Serdar Ümit; Altun, Demet; Erdeve, Ömer

doi:10.1007/s00431-009-0964-6

Cited by 30 publications

(16 citation statements)

References 9 publications

(23 reference statements)

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“…Clinical features of this syndrome were elaborated by Freudental in 1924 and Nicolau in 1925 7 8. The phenomenon has been reported in association with the administration of a variety of medications including diclofenac,6 penicillins,6 9 vitamin K10 and etanercept 11. The typical presentation is blanching and pain around the injection site soon after injection, followed by erythema, livedoid patch, haemorrhagic patch and finally tissue necrosis.…”

Section: Discussionmentioning

confidence: 99%

Naltrexone-induced Nicolau syndrome masquerading as cutaneous abscess

2012

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Nicolau syndrome—also known as Embolia Cutis Medicamentosa—is a rare complication of intramuscular and subcutaneous injections manifesting as necrosis of skin and the underlying tissues. The exact pathogenesis is uncertain. There are several hypotheses including direct damage to the end artery, cytotoxic effects of the implicated drug or additives in the injectable preparations. Naltrexone is a long-acting opioid antagonist used primarily in the management of alcohol and opioid dependence. The patient received intramuscular naltrexone for treatment of alcoholism. A week later, she presented with what appeared to be cellulitis at the site of injection. It progressed in spite of antibiotics and mimicked an abscess. Attempted incision and drainage however yielded no pus. Deep tissue necrosis was seen and histopathology was consistent with Nicolau syndrome. As per our knowledge, this is the first reported case of naltrexone associated Nicolau syndrome that masqueraded as a buttock abscess.

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Section: Discussionmentioning

confidence: 99%

Naltrexone-induced Nicolau syndrome masquerading as cutaneous abscess

2012

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“…Most cases relate to intramuscular injections but subcutaneous injections have also been described as precipitating the condition [1][2][3][4] . A wide variety of medications have been noted as having been injected at the time the condition commenced including bismuth, antibiotics, vitamin K, alpha and beta interferon, diclofenac and etanercept [5][6][7][8][9][10] . There is also a single case of ECM after sclerotherapy of intracutaneous veins with polidocanol in the literature [1] .…”

Section: Discussionmentioning

confidence: 99%

Embolia cutis medicamentosa after polidocanol injection of neovessels in Achilles tendinosis

Humphries¹

2013

Grand Rounds

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This report documents a case of embolia cutis medicamentosa after therapeutic injection of neovessels associated with Achilles tendinosis with polidocanol. This condition has not previously been reported as a complication of this procedure.A 51-year-old woman presented with an 18-month history of Achilles tendinosis. The clinical findings were consistent with this diagnosis. Ultrasound scanning confirmed typical changes of tendinosis in body of the tendon with florid neovascularity seen on power Doppler mode. No frank disruption of the tendon structure was seen. The treatment modalities trialled up to that point had included activity modification, an eccentric exercise program, glyceryl trinitrate patches, steroid iontophoresis and prolotherapy without resolution of her problem. She was advised that injecting polidocanol (a non-ionic detergent used as a sclerosing agent) into the neovessels was an accepted method of treating the pain of recalcitrant Achilles tendinosis. The risks of such a procedure, including infection, allergic reaction and short-term increases in pain, were explained. The injection was performed under ultrasound guidance by a procedural radiologist highly experienced in this particular technique. The neovessels on the anterior surface of the body of the tendon were injected with 2 ml of 1% polidocanol solution. There was no abnormal leakage of the polidocanol during the injection. The patient described severe pain at the time of injection in both the area of the injection and in the posterior calf muscles.Over the next 7 days her pain intensified to the point that she was unable to bear weight. A well-demarcated change became apparent in the cutaneous and subcutaneous tissues (Fig. 1). After a literature search, a diagnosis of embolia cutis medicamentosa (ECM) was made and she was referred to the plastic surgical team at the regional teaching hospital. Management consisted This paper is available online at http://www.grandrounds-e-med.com. In the event of a change in the URL address, please use the DOI provided to locate the paper.

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“…[1] Nicolau syndrome was first described in patients receiving intramuscular injection of Bismuth salt for the treatment of syphilis in early nineteenth century. Since then, cases of Nicolau syndrome has been reported with the administration of penicillin, [2] diclofenac sodium, [3] glatimer acetate, [4] vitamin K, [5] and etanercept. [6] Diagnosis is essentially clinical keeping in mind the temporal relation after administration of drugs and management includes controlled debridement, pain control and dressing care.…”

Section: Introductionmentioning

confidence: 99%

A fatal case of Nicolau syndrome

Madke

Kar

Prasad

et al. 2014

Indian J Paediatr Dermatol

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had few febrile episodes with chills for which they sought opinion of a physician and hence received intramuscular injections of diclofenac sodium and gentamicin. The parents denied any preceding history trauma or snake bite. Clinical examination showed a large tender necrotic hemorrhagic denuded patch on right buttock and sacrococcygeal region with extension into inter-gluteal cleft [ Figure 1]. Skin around the necrotic patch showed purplish livedo reticularis like dermatitis. Nikolskiy's sign was positive on the necrotic area. Rest of the cutaneous and mucosal examination was unremarkable. On the 2 nd day of admission, necrotic lesion progressed to other buttock and lumbosacral region. His complete hemogram and urinalysis were within normal range for age. Serology for malarial parasite and dengue virus were nonreactive. However, liver enzymes were markedly raised with alanine transaminase: 1300 units/L; (normal range: 7-55 units/L) and aspartate transaminase: 1118 units/L (normal range: 8-48 units/L) suggesting acute hepatocellular damage. Keeping in mind the temporal association between administration of injectable drug and development of cutaneous lesions, we made a diagnosis of Nicolau syndrome. However, on 3 rd day of admission, we found the patient unconscious and were not responding to verbal or mechanical stimuli. Despite the resuscitative measure, the patient succumbed. A postmortem examination was advised to ascertain the cause of death, which was however denied by the parents. ABSTRACTNicolau syndrome (embolia cutis medicamentosa) is a rare cutaneous adverse reaction occurring at the site of intramuscular, intra-articular or, rarely, subcutaneous injection of particular drugs. We hereby report a fatal case of Nicolau syndrome in a 13-year-old young male patient.

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Nicolau syndrome induced by intramuscular vitamin K in a premature newborn

Cited by 30 publications

References 9 publications

Naltrexone-induced Nicolau syndrome masquerading as cutaneous abscess

Naltrexone-induced Nicolau syndrome masquerading as cutaneous abscess

Embolia cutis medicamentosa after polidocanol injection of neovessels in Achilles tendinosis

A fatal case of Nicolau syndrome

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