Nicolau Syndrome in Patient Following Diclofenac Administration: A Case Report

Kim, Kwang Kyoun

doi:10.5021/ad.2011.23.4.501

Cited by 32 publications

(36 citation statements)

References 6 publications

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“…En República Dominicana se registra el primer caso en el año 2017, el cual fue manejado con tratamiento convencional. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Se considera una complicación rara tras la administración de inyecciones intramusculares, subcutáneas, intravenosas o intraarticulares de medicamentos, entre los que podemos citar: AINES, vitamina K, penicilina, antihistamínicos, corticosteroides, anestésicos locales, vacunas, polidocanol e interferón pegilado alfa 1,14 .…”

Section: Discussionunclassified

Síndrome de Nicolau. Manejo conservador. Caso clínico

Alba

Fernández

Pérez

et al. 2019

cysa

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ResumenIntroducción: el síndrome de Nicolau, embolia cutis o dermatitis livedoide, es una reacción adversa poco frecuente a la administración de inyección intramuscular, subcutánea o intraarticular de medicamentos, inicia con dolor intenso y eritema que evoluciona a lesión livedoide que se torna hemorrágica, progresa a necrosis isquémica de piel y tejidos más profundos.Caso clínico: niño de 7 meses de edad, luego de inyección intramuscular de metamizol sódico presenta llanto continuo, seguido de lesión purpúrica afectando espalda, glúteo, muslo y pierna derechos, evolucionando hasta cicatrización total en 18 semanas.Conclusión: el síndrome de Nicolau, condición iatrogénica por inyección de múltiples medicamentos, produce lesión necrótica en área de irrigación de vasos afectados. El conocimiento de este síndrome facilitaría su prevención, al igual que su diagnóstico y manejo tempranos.Palabras clave: síndrome de Nicolau; inyección intramuscular; metamizol sódico monohidratado; manejo conservador; niños. AbstractIntroduction: Nicolau syndrome, embolism cutis or livedoid dermatitis, is a rare adverse reaction to the administration of intramuscular, subcutaneous or intra-articular injection of drugs, begins with intense pain and erythema that progresses to a livedoid lesion that becomes hemorrhagic, progresses to ischemic necrosis of skin and deeper tissues. Clinical case:A 7-month-old boy, after intramuscular injection of sodium metamizole, presented continuous crying followed by a purpuric lesion affecting the right back, gluteus, thigh and leg, evolving to total healing in 18 weeks. Conclusion:Nicolau Syndrome, iatrogenic condition by injection of multiple drugs, produces necrotic lesion in irrigated area of affected vessels. The knowledge of this syndrome would facilitate its prevention, as well as its early diagnosis and management.

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Section: Discussionunclassified

Síndrome de Nicolau. Manejo conservador. Caso clínico

Alba

Fernández

Pérez

et al. 2019

cysa

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“…The common theory is localized arterial occlusion by an embolus or after vessel damage . Acute vasospasm due to arterial embolus, sympathetic nerve stimulation or inflammation of the intima is believed to be responsible for both the intense localized pain as well as ischemia of supplied tissues . The diagnosis of Nicolau syndrome is clinical rather than histological .…”

Section: Discussionmentioning

confidence: 99%

“…Acute vasospasm due to arterial embolus, sympathetic nerve stimulation or inflammation of the intima is believed to be responsible for both the intense localized pain as well as ischemia of supplied tissues . The diagnosis of Nicolau syndrome is clinical rather than histological . Patients typically experience immediate onset of severe pain at the injection site, followed within hours by redness and ecchymotic reticular or livedoid changes of the skin .…”

Section: Discussionmentioning

confidence: 99%

Nicolau syndrome and localized panniculitis: a report of dual diagnoses with an emphasis on morphea profunda‐like changes following injection with glatiramer acetate

et al. 2016

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Glatiramer acetate, given as a 40 mg subcutaneous injection thrice weekly, was recently approved by the FDA based on data suggesting better compliance and a more favorable side effect profile compared to lower dose, daily dosing. The most commonly reported adverse events are transient injection site reactions involving redness and pain at the site; however, more pronounced panniculitis and lipoatrophy have also been reported. Here, we present the case of a 51-year-old female treated with higher dose glatiramer acetate who presented with a cutaneous injection site reaction consistent with Nicolau syndrome. The excised specimen revealed typical glatiramer acetate-associated panniculitis, alongside subcutaneous sclerosis. This case shows the spectrum of cutaneous complications possible with glatiramer acetate injections, the finding of sclerosis being relatively infrequently reported. Given the relatively short duration of trials leading to FDA approval of thrice weekly dosing of glatiramer acetate, clinicians should perform careful clinical and histopathological evaluation and reporting of patients who experience injection site reactions.

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“…This so-called perforosome concept gave us the inspiration of replacing a damaged perforator site with a perforator-based flap harvested from an adjacent region [15]. Diclofenac is one of the most commonly reported nonsteroidal anti-inflammatory drugs to cause NS [2,5,7,[18][19][20]. Vasoconstructive effect of diclofenac is attributed to reduction of prostaglandin synthesis via cyclooxygenase inhibition in NS pathogenesis [21].…”

Section: Discussionmentioning

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 Syndrome in Patient Following Diclofenac Administration: A Case Report

Cited by 32 publications

References 6 publications

Síndrome de Nicolau. Manejo conservador. Caso clínico

Síndrome de Nicolau. Manejo conservador. Caso clínico

Nicolau syndrome and localized panniculitis: a report of dual diagnoses with an emphasis on morphea profunda‐like changes following injection with glatiramer acetate

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

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