Nicolau Syndrome After Glatiramer Acetate Injection in Close Proximity to Administration of SARS-CoV-2 mRNA Vaccine

Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare complication of injectable drugs. Patients present with pain at injection site, followed by swelling, erythema, purple, hemorrhagic patches and lastly ulcer formation. A variety of intramuscular agents have been implicated as responsible. We report a case of a 26-year-old woman with a history of a purple lesion on her thigh who was diagnosed with Nicolau syndrome due to subcutaneous administration of glatiramer acetate. The patient was followed up with topical mupirocin. On follow-up, although the patient stated that she continued using glatiramer acetate, no new lesions appeared and the existing lesion continued to shrink. Nicolau syndrome seems to have an unpredictable and unavoidable course. This case suggests that physicians should have a high index of suspicion for the presence of Nicolau syndrome in patients presenting with necrotic or ulcerative lesions with a history of using injectable drugs.

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Embolia Cutis Medicamentosa (Nicolau Syndrome) After Glatiramer Acetate Injection

Actas Dermo-Sifiliográficas (English Edition) ◽

10.1016/j.adengl.2011.11.013 ◽

2011 ◽

Vol 102 (9) ◽

pp. 742-744

Author(s):

C. Martínez-Morán ◽

P. Espinosa-Lara ◽

L. Nájera ◽

A. Romero-Maté ◽

S. Córdoba ◽

...

Keyword(s):

Glatiramer Acetate ◽

Nicolau Syndrome ◽

Embolia Cutis Medicamentosa

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Case Report: Two Cases of Nicolau Syndrome Associated with Glatiramer Acetate

International Journal of MS Care ◽

10.7224/1537-2073.2016-038 ◽

2017 ◽

Vol 19 (3) ◽

pp. 148-150 ◽

Cited By ~ 1

Author(s):

Dorlan J. Kimbrough ◽

Scott D. Newsome

Keyword(s):

Glatiramer Acetate ◽

Skin Necrosis ◽

Rare Complication ◽

Skin Lesions ◽

Drug Induced ◽

Length Of Treatment ◽

Disease Modifying Therapy ◽

Nicolau Syndrome ◽

Embolia Cutis Medicamentosa ◽

Disease Modifying

We report two cases of Nicolau syndrome (embolia cutis medicamentosa), a rare complication of injectable medications, both associated with the administration of 20 mg of subcutaneous glatiramer acetate. Both patients required surgical debridement and were subsequently treated conservatively without additional complications. Patient 1 opted to discontinue disease-modifying therapy. Patient 2 continued glatiramer acetate therapy without complications by using other injection sites. These cases highlight the need for prompt investigation of new unusual skin lesions in patients receiving injectable multiple sclerosis treatments (regardless of length of treatment and previous minor cosmetic concerns) and illustrate the clinical distinction between Nicolau syndrome and drug-induced skin necrosis.

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

Journal of Cutaneous Pathology ◽

10.1111/cup.12791 ◽

2016 ◽

Vol 43 (11) ◽

pp. 1056-1061 ◽

Cited By ~ 6

Author(s):

Sarah E. Mott ◽

Zachary G. Peña ◽

Rebecca I. Spain ◽

Kevin P. White ◽

Benjamin D. Ehst

Keyword(s):

Glatiramer Acetate ◽

Nicolau Syndrome ◽

Dual Diagnoses

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Effects of Vincristine on Endothelial Microtubules in the Spinal Cord

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100090270 ◽

1976 ◽

Vol 34 ◽

pp. 58-59

Author(s):

John L. Beggs ◽

John D. Waggener ◽

Wanda Miller

Keyword(s):

Spinal Cord ◽

Biological Activity ◽

Horseradish Peroxidase ◽

Transport Mechanism ◽

Vasogenic Edema ◽

Vesicular Transport ◽

Close Proximity

Microtubules (MT) are versatile organelles participating in a wide variety of biological activity. MT involvement in the movement and transport of cytoplasmic components has been well documented. In the course of our study on trauma-induced vasogenic edema in the spinal cord we have concluded that endothelial vesicles contribute to the edema process. Using horseradish peroxidase as a vascular tracer, labeled endothelial vesicles were present in all situations expected if a vesicular transport mechanism was in operation. Frequently,labeled vesicles coalesced to form channels that appeared to traverse the endothelium. The presence of MT in close proximity to labeled vesicles sugg ested that MT may play a role in vesicular activity.

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