Can betamethasone prevent Nicolau syndrome when coadministered with penicillin? A case report

Abstract

We present a 33‐year‐old female patient with Nicolau syndrome (NS) who received one injection of benzathine penicillin and one injection of betamethasone to the right buttock, and one injection of benzathine penicillin to the left. NS was seen only in the left buttock, where it was intramuscularly injected with penicillin benzathine alone.

Nicolau syndrome after intramuscular injection of methocarbamol: A rare case report

“…Methocarbamol is thought to cause vasoconstriction and tissue ischemia when injected intramuscularly, which can lead to tissue necrosis. Additionally, the drug may have a direct cytotoxic effect on the cells, further exacerbating tissue damage [12] .…”

Nikolau Syndrome: Necrotic Activity of Drugs and Ways to Prevent Post-Injection Abscesses (In memory of Professor László A Gömze)

“…At the same time, for many years, many researchers around the world have been looking to explain the pathological role of drugs, the injection of which caused Nicolau syndrome. Th e fi ndings show that Nicolau syndrome can develop after injections of local anesthetics, steroid and nonsteroidal anti-infl ammatory drugs, chemotherapeutic agents, vaccines and some other drugs, as well as aft er injections of combined drugs [23,[33][34][35][36]. However, until recent years, no one has been able to explain exactly what the mechanism of action of drugs is, which is the cause of Nicolau syndrome progression.…”

“…Th e discovery of the mechanism of drug irritating and cauterizing action in areas of injection and the reasons why modern medicines, considered to be of high quality, can have such an eff ect, explained not only the nature of Nicolau syndrome induction, but also indicated the right direction for the search and development of eff ective ways to prevent local post-injection complications. In particular, the discovery of the necrotic eff ect of drugs, manifested by local interaction in the presence of excessively high hypertensive activity, acid activity, or in the presence of alcohols, aldehydes and heavy metal salts in cauterizing concentrations [18,38], explains the speed of the local pain syndrome induction [33,42] and aseptic infl ammation and necrosis that occur when injecting anti-infective agents [35,36]. So, the lack of modern quality control of medicines allows for the use of injection solutions in medical practice, some of which have necrotic activity.…”

Thermal imaging of local skin temperature as part of quality and safety assessment of injectable drugs

“…Among complex local post-injection complications, reversible and irreversible local inflammation, severe local pain syndrome, necrosis, and abscess are the most unpredictable and unexplained [ [26] , [27] , [28] ]. This specific complication was described approximately 100 years ago [ 29 ], and is now called Nicolau syndrome [ [30] , [31] , [32] , [33] , [34] , [35] ]. These complications are not caused by injection of any specific drug, and cannot be explained by the known mechanisms of drug action.…”