Nicolau's syndrome in a newborn caused by triple DTP (diphtheria-tetanus-pertussis) vaccination

Erkek, Emel; Tuncez, Fatma; Sanli, Cihat; Duman, Deniz; Kurtipek, Gülcan Saylam; Bağci, Yeter; Ayaslioglu, Ergin

doi:10.1016/j.jaad.2005.09.046

Cited by 28 publications

(16 citation statements)

References 5 publications

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“…NS has been reported in infants as young as 3 months of age following triple diphtheria-tetanus-pertussis vaccination [2]. This patient is, to our knowledge, the youngest case to suffer from livedoid skin necrosis and the first case due to intramuscular administration of vitamin K1 in newborns.…”

Section: Case Reportmentioning

confidence: 66%

“…With the first description of this syndrome by the use of bismuth salts for syphilis in 1925, several other drugs causing NS such as pyrazolone derivatives, diclofenac, vitamin B complex, streptomycin, lidocaine, phenobarbital, chlorpromazine, dexamethasone, triamcinolone, diphenhydramine and interferon alfa have been reported in time. Cases of NS due to intramuscular antiflu and triple diphtheria-tetanus-pertussis vaccinations have also been described [2,4,5]. Although its pathogenesis is not well understood, the pathophysiology of NS probably involves intra-arterial and⁄or para-arterial injection and arterial embolism of viscous suspensions of drugs meant for intramuscular, intravenous or intra-articular injection, followed by acute vasospasm, hence, the livedo-like appearance [4].…”

Section: Case Reportmentioning

confidence: 99%

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Nicolau syndrome induced by intramuscular vitamin K in a premature newborn

et al. 2009

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Section: Case Reportmentioning

confidence: 66%

Section: Case Reportmentioning

confidence: 99%

Nicolau syndrome induced by intramuscular vitamin K in a premature newborn

et al. 2009

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“…Segundo é relatado, os acidentes ocorrem com o uso de uma vasta gama de remédios tais como corticosteroides, penicilinas, interferon alfa, metoclopramida, pirazolonas, anestésicos, noradrenalina, fenobutazona, diclofenaco, quimioterápicos, vitaminas e outros 47 . Os produtos oleosos mais citados são os bismúticos, os mercuriais, os balsâmicos e as penicilinas.…”

Section: Sintomas E Sinaisunclassified

Acidente por injeção medicamentosa no músculo deltoide: lesões locais e à distância, revisão de 32 casos

Duque

Chagas

2009

J. vasc. bras.

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IntroduçãoO advento da seringa de injeção hipodérmica em 1853 (Charles Gabriel Pravaz), logo seguida da fabricação da seringa inteiramente de vidro em 1869 (Georg Wilhelm Amathus Luer), permitiu a administração de medicamentos via parenteral. O novo processo fez sucesso, mas, imediatamente, surgiram as complicações. ARTIGO DE REVISÃO ResumoAnálise de 32 casos de acidentes por injeção, na maioria das vezes, de substâncias oleosas no músculo deltoide. Os acidentes caracterizaram-se por dor e reações tróficas locais. Em muitos casos, simultaneamente, ocorreram distúrbios isquêmicos nas regiões escapular, peitoral e, especialmente, na extremidade do membro. Presume-se que esse complexo lesional é gerado: 1) pela ação lesiva do medicamento nas terminações nervosas, nos tecidos moles e perivasais; e/ou 2) pela entrada fortuita da substância no interior dos vasos, produzindo embolia e/ou endotelite trombosante; e/ou 3) pelo despertar de fenômenos vasomotores.As lesões da mão, geralmente, foram mais graves que as lesões deltoidianas, com a eventual perda de dedos, espontânea ou cirúrgica. Os diversos quadros clínicos do acidente foram semelhantes, mas algumas características lesionais permitiram identificar mecanismos fisiopatogênicos peculiares, o que tem significado conceitual e terapêutico. Palavras-chave:Dermite livedoide, arterite cútis medicamentosa, embolia cútis medicamentosa, síndrome de Nicolau, síndrome de Freudenthal, acidente por injeção intramuscular, gangrena de mão. AbstractAnalysis of 32 cases of accidental injection of oily suspension (in most cases) into the deltoid muscle is reported. Pain and local ulcers characterized the accidents. In many cases, simultaneous ischemic disorders were observed in the scapular and pectoral regions and especially in the end of the upper limb. It is presumed that this complex lesion was caused by 1) the harmful action of the medication on nervous terminations, soft and perivascular tissues; and/or 2) occasional entrance of the substance into blood vessels, causing embolism and/or thrombotic endothelitis; and/or 3) vasomotor phenomena.Hand injuries were generally more severe than injuries in the deltoid region, with occasional spontaneous or surgical loss of fingers. Clinical statuses were similar, though some lesions had features, which allowed identification of peculiar physiopathogenic mechanisms, with conceptual and therapeutic significance.

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“…The actual physiopathology of the NS is yet unknown; it has been proposed that the direct arterial damage and vasoconstrictive effects of various drugs may induce inflammation and subsequently cause skin necrosis [2,3]. Agents, such as nonsteroidal anti-inflammatory drugs, steroids, vitamines, benzathine penicillin, hydroxyzine, vaccines i.e., are reported to be potential triggering factors of this clinical entity [2,[4][5][6][7][8][9][10][11][12][13]. There is no consensus on the treatment protocol of the disease.…”

Section: Introductionmentioning

confidence: 99%

Freestyle Perforator-Based Fasciocutaneous Flap Reconstruction in Nicolau Syndrome-Related Tissue Necrosis

et al. 2015

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The actual pathology of the Nicolau syndrome (NS) is still unknown. It is thought to involve direct vascular damage and vasospasm. Many NS cases were reported in the literature but a treatment protocol is still not established. However, after demarcation of the necrotic tissue, surgical intervention is mandatory. Five NS cases with extensive tissue necrosis on the upper lateral gluteal region were analyzed retrospectively. Operative technique was described in details for freestyle perforator-based fasciocutaneous flaps from the gluteal region to reconstruct defects of NS-related tissue necrosis. Freestyle perforator-based fasciocutaneous flaps were used for defect closure in all patients. All flaps survived totally. No complications occurred during the follow-up period. Although rare, NS is a serious complication of inadvertent intramuscular injections. Prevention is the best treatment. However, in case of large-tissue necrosis, freestyle perforator-based fasciocutaneous flaps harvested from the gluteal region is a satisfactory option for reconstruction.

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Nicolau's syndrome in a newborn caused by triple DTP (diphtheria-tetanus-pertussis) vaccination

Cited by 28 publications

References 5 publications

Nicolau syndrome induced by intramuscular vitamin K in a premature newborn

Nicolau syndrome induced by intramuscular vitamin K in a premature newborn

Acidente por injeção medicamentosa no músculo deltoide: lesões locais e à distância, revisão de 32 casos

Freestyle Perforator-Based Fasciocutaneous Flap Reconstruction in Nicolau Syndrome-Related Tissue Necrosis

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