Nicolau Syndrome Due to Intramuscular Diclofenac Sodium Injection

Abstract

Nicolau syndrome (NS) is a rare complication characterized by tissue necrosis that occurs after parenteral injection of drugs. The exact pathogenesis is uncertain, but there are several hypotheses, including direct damage to the end artery, acute vasospasm and cytotoxic effects of the drug. Severe pain in the immediate post injection period and purplish discoloration of the skin with reticulate pigmentary pattern is characteristic of this syndrome. Diagnosis is mainly clinical and there is no standard treatment for the disease. Herein, we present a rare case of NS due to Diclofenac Sodium (Voltaren®) injection in an 80-year-old female suffering from Lower Respiratory Tract Infection (LRTI) who was managed conservatively.
 Keywords: Nicolau Syndrome, Embolia cutis medicamentosa, Voltaren, Diclofenac sodium

Nicolau’s syndrome following intramuscular administration of Diclofenac sodium

“…Nicolau's syndrome was first described by Freudenthal and Nicolau in the 19 th century in patients following intramuscular injection of bismuth salt for the treatment of syphilis. [2] Various medicaments including penicillin, diclofenac sodium, intramuscular Vitamin K, local anesthetics, anti-rheumatic drugs, phenobarbitone, sulfonamides, sclerotherapy, and subcutaneous etanercept have been implicated in causing Nicolau's syndrome. [3] It can also occur following intramuscular Naltrexone injection.…”

“…Preventive measures are proper aseptic care while administrating injections and follow Z track method of intramuscular injection. [2] The following precautions to be taken by the health-care professionals while giving intramuscular injections:…”