Sonographic findings in Nicolau syndrome following intramuscular diclofenac injection: A case report

Park, Heejin; Kim, Mi-Sung; Park, Noh-Hyuk; Jung, Sang-Won; Park, Sung-Il; Park, Chan-Sub

doi:10.1002/jcu.20743

Cited by 20 publications

(19 citation statements)

References 6 publications

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“…Diclofenac is a well‐known NSAID and often used to relief skeletal muscle pain, but extremely few adverse effects on mature skeletal muscle have been reported thus far. Recently, a case report described that a 34‐year‐old woman after intramuscular injection of diclofenac sodium suffered an extensive edema on gluteal and piriformis muscles (Park et al, 2011). Therefore, diclofenac has adverse effect on adult's muscles although the reported case is rare.…”

Section: Discussionmentioning

confidence: 99%

Embryonic exposure to diclofenac disturbs actin organization and leads to myofibril misalignment

Chen

Chang

Wang

et al. 2011

Birth Defects Research Pt B

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The objective of this study was to investigate the embryotoxicity of diclofenac. Zebrafish (Danio rerio) embryos at 12 hpf were treated with different dosages of diclofenac (0-2,000 ppm) for different time courses (12-72 hr). Results showed no evident differences in survival rates or morphological changes between the mock-treated control (0 ppm) zebrafish embryos and those with 1-ppm diclofenac-exposure (12-24, 12-36 hpf). In contrast, after higher doses (5 and 10 ppm) of exposure, embryos displayed some defective phenotypes, including malformed somite boundary, a twisted body axis, and shorter body length. In addition, diclofenac-treated embryos exhibited significantly reduced frequencies of spontaneous in-chorion contractions in comparison with mock-control littermates (mock-control: 13.20 ± 2.24 vs. 5-10 ppm diclofenac: 6.66 ± 1.35-3.03 ± 1.84). Subtle changes were easily observed by staining with specific monoclonal antibodies F59 and phalloidin to detect morphological changes in muscle fibers and formation of F-actin, respectively. Our data show that diclofenac treatment disturbs actin organization and muscle fiber alignment, thus causing malformed somite phenotypes.

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Section: Discussionmentioning

confidence: 99%

Embryonic exposure to diclofenac disturbs actin organization and leads to myofibril misalignment

Chen

Chang

Wang

et al. 2011

Birth Defects Research Pt B

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“…Marangi et al showed this macroscopically by dissecting the necrotic area on a thrombotic vessel [16]. This viewpoint was also supported by sonographic findings of Park et al and mirror Doppler mapping of nonaffected cutaneous territories by Uri and Arad in NS cases [7,17]. Focal thrombosis in associated vessels was also observed in [4].…”

Section: Discussionmentioning

confidence: 75%

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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“…En nuestro caso, el diagnóstico fue clínico, la sonografía evidenció edema de partes blandas en región glútea y la biopsia de piel reportó necrosis marcada de células de la epidermis, trombosis en plexos vasculares medios y profundos. 1,15 En la mayoría de los casos el pronóstico del síndrome de Nicolau es la curación, con cicatrices atróficas o pigmentación restantes, como ocurrió en nuestro paciente. No obstante, en casos raros, puede causar complicaciones como hipoestesia, paraplejia, deficiencia del esfínter o sepsis.…”

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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Sonographic findings in Nicolau syndrome following intramuscular diclofenac injection: A case report

Cited by 20 publications

References 6 publications

Embryonic exposure to diclofenac disturbs actin organization and leads to myofibril misalignment

Embryonic exposure to diclofenac disturbs actin organization and leads to myofibril misalignment

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

Síndrome de Nicolau. Manejo conservador. Caso clínico

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