Síndrome de Nicolau de desenvolvimento tardio: relato de caso

Abstract

Nicolau syndrome also known as Embolia cutis medicamentosa and Livedoid dermatitis is a rare complication characterized by tissue necrosis that occurs after injection of medicines. We describe a case of late development of Nicolau syndrome following intra-articular infiltration with corticosteroid. Keywords: Adrenal Cortex Hormones; Dermatitis; Necrosis; Seepage Resumo: A Síndrome de Nicolau, também conhecida como Embolia Cutis Medicamentosa e Dermatite Livedóide, é uma rara complicação caracterizada por necrose tecidual que ocorre após a injeção de medicamentos. Descrevemos um caso de Síndrome de Nicolau de curso tardio, posterior à infiltração intra-articular com corticóide.

Post-injection embolia cutis medicamentosa – Nicolau Syndrome: case report and literature review

“…Nicolau syndrome can also be similar to an abscess. 3,4,14,17,23,24 There is no standard treatment established for NS, since it has a low incidence. In most cases, methods such as surgical debridement and local repair through grafts or myocutaneous flap combined with anticoagulants, pentoxifylline, hyperbaric chamber, steroids, intravenous alprostadil, corticosteroids and analgesics are employed until the lesion is completely healed.…”

“…Pentoxifylline can also be used, since it is a phosphodiesterase inhibitor that improves blood cell deformability and improves blood flow conditions by reducing vasospasm. 3,13,18,24 Ice compresses should be avoided because they increase vasoconstriction, thereby worsening the condition. 25 Prevention of NS can be achieved by adopting the following precautionary measures: injecting the drug in the upper and outer quadrant of the gluteal region, because this area has fewer large caliber vessels; performing syringe aspiration before injecting the drug to test for the presence of blood; utilizing the Z technique for intramuscular injections; respecting the 5 ml limit; alternating the injection site in cases of multiple doses or long treatments; and using a needle that is longer than 3.8 cm in obese patients.…”

Extensive Nicolau syndrome following intramuscular diclofenac sodium injection

“…The onset is usually sudden in relation to the injection but can be delayed, often without injury to the injected site. 4 The prognosis is unpredictable, with reports of recovery and atrophic scarring at the affected site but also compartment syndrome, hyperkalemia, renal failure, paralysis of the affected limb, and death. 3 , 5 The diagnosis is clinical, highly suggestive when the lesion starts at the injection site, with distal progression over the injected limb.…”

“… 1 The correct intramuscular injection technique can reduce the risk of the condition. 4 The Z-track injection method is recommended, with traction of the skin and subcutaneous tissue prior to needle insertion, ensuring blockage of the needle path after the injection. 1 …”