Nicolau Syndrome, Masquerader of Postinjection Sciatic Nerve Injury: Case Report and Review of Literature

Raju, Bharath; Ashraf, Omar; Jumah, Fareed; Gowda, Naveen Mandya Appaji; Gupta, Gaurav; Sun, Hai; Nanda, Anil

doi:10.1016/j.wneu.2020.07.029

Cited by 8 publications

(12 citation statements)

References 35 publications

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“…Due to axonopathy and injury in one or more nerves at the injection site, symptoms can occasionally spread to other organs, such as the shoulder, thigh, knee, and ankle. 14,56 Additionally, dizziness, fainting, loss of consciousness or cognitive changes have been reported in some cases. 56,99,100 As well, it was observed that some normal functions could be disrupted due to the location and extent of the damaged nerve, which can consequently lead to nausea, vomiting, loss of bladder or bowel control, renal failure, and even death.…”

Section: Symptomsmentioning

confidence: 99%

“…14,56 Additionally, dizziness, fainting, loss of consciousness or cognitive changes have been reported in some cases. 56,99,100 As well, it was observed that some normal functions could be disrupted due to the location and extent of the damaged nerve, which can consequently lead to nausea, vomiting, loss of bladder or bowel control, renal failure, and even death. 40,56,61 Dermatological manifestations usually appear from the beginning of the initial phase.…”

Section: Symptomsmentioning

confidence: 99%

“…56,99,100 As well, it was observed that some normal functions could be disrupted due to the location and extent of the damaged nerve, which can consequently lead to nausea, vomiting, loss of bladder or bowel control, renal failure, and even death. 40,56,61 Dermatological manifestations usually appear from the beginning of the initial phase. Correspondingly, these contain paleness, erythema, and livedoid violaceous patch at the injection site, as well as a hemorrhagic lesion, contributing to cutaneous necrosis.…”

Section: Symptomsmentioning

confidence: 99%

“…1 Moreover, other differential diagnoses of this syndrome are the following: local toxic reaction to drugs, acute compartment syndrome, vasculitis, fat embolism, and Hoigne's syndrome. 56 Injection nerve injury diagnosis, which could lead to nerve palsy, is known as another differential that puts unqualified staff injecting into an inappropriate site. Although Nicolau syndrome almost presents dermatological symptoms, usually there are no dermatological symptoms caused by the injection nerve injury.…”

Section: Diagnosismentioning

confidence: 99%

“…Although Nicolau syndrome almost presents dermatological symptoms, usually there are no dermatological symptoms caused by the injection nerve injury. 56,107,108 Cellulitis is another differential diagnosis whose misdiagnosis could consequently lead to antibiotics administration and treatment failure. 109 Gas gangrene and necrotizing fasciitis are acute infections considered as other differential diagnoses for Nicolau syndrome.…”

Section: Diagnosismentioning

confidence: 99%

See 4 more Smart Citations

Nicolau syndrome: a review of case studies

Mojarrad¹,

Mollazadeh²,

Barikbin³

et al. 2021

Pharm Sci

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Nicolau syndrome, although it is quite rare, often occurs following intramuscular injections of different medications, especially diclofenac and penicillins. Accordingly, its symptoms usually begin with severe pain during injection, leading to ulceration and necrosis of the local tissue over time. Immediate diagnosis and treatment in the case of this syndrome, are of great importance. There are no established criteria for Nicolau's diagnosis, and preferably, these can be achieved by examining the patient's symptoms and eliminating differential diagnoses. The proposed treatments are primarily symptomatic therapy and measures such as fasciotomy, debridement, and plastic surgery provided in the affected area. The exact cause of this syndrome has not been determined yet. However, since vasospasm, thrombosis, and embolism have been observed in majority of Nicolau syndrome cases, so any intra-arterial/para-arterial injection or any other factor leading to these three conditions could be hypothetically regarded as the cause of this problem. This review aims to provide a comprehensive overview of Nicolau's symptoms, diagnosis, treatment methods, and prevention. It also investigates the association between the incidence of this disease and some factors such as gender, age, injection method, and causative drugs, in order to widen our understanding on this syndrome and help practitioners with a much faster diagnosis method and step-by-step approach to Nicolau syndrome.

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Section: Symptomsmentioning

confidence: 99%

Section: Symptomsmentioning

confidence: 99%

Section: Symptomsmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

See 3 more Smart Citations

Nicolau syndrome: a review of case studies

Mojarrad¹,

Mollazadeh²,

Barikbin³

et al. 2021

Pharm Sci

View full text Add to dashboard Cite

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Nicolau syndrome following glatiramer acetate for multiple sclerosis: Case and review of reports

Udawatta,

Mateen

2024

Ann Clin Transl Neurol

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Nicolau syndrome is a rare, iatrogenic skin reaction after parental drug administration, characterized by severe pain at an injection site, followed by hemorrhage, ulceration, and often necrosis. We present a case of a patient on glatiramer acetate for many years (initially Copaxone then Glatopa) who developed Nicolau syndrome, the second reported case after generic glatiramer acetate. All reported cases of Nicolau syndrome after glatiramer acetate are reviewed. The case highlights the importance of prompt recognition of this skin reaction by neurologists and raises awareness of the risks of skin reactions even in low‐risk injectable DMTs.

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Benzathine-benzylpenicillin

2020

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Nicolau Syndrome, Masquerader of Postinjection Sciatic Nerve Injury: Case Report and Review of Literature

Cited by 8 publications

References 35 publications

Nicolau syndrome: a review of case studies

Nicolau syndrome: a review of case studies

Nicolau syndrome following glatiramer acetate for multiple sclerosis: Case and review of reports

Benzathine-benzylpenicillin

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