NICOLAU SYNDROME DUE TO INTRAMUSCULAR DICLOFENAC SODIUM INJECTION

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Harris I Shaafie ◽  
Soumya Agarwal ◽  
Swosti Mohanty ◽  
Chandni Jain
Keyword(s):  
Standard Treatment ◽  
Rare Complication ◽  
Diclofenac Sodium ◽  
Tissue Necrosis ◽  
Cytotoxic Effects ◽  
Direct Damage ◽  
Nicolau Syndrome ◽  
Syndrome Diagnosis ◽  
Embolia Cutis Medicamentosa ◽  
Pigmentary Pattern

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

scholarly journals Case Report: Nicolau syndrome due to etofenamate injection

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 867 ◽  
Author(s):  
Emin Ozlu ◽  
Aysegul Baykan ◽  
Ragıp Ertas ◽  
Yılmaz Ulas ◽  
Kemal Ozyurt ◽  
...  
Keyword(s):  
Severe Pain ◽  
Standard Treatment ◽  
Rare Complication ◽  
Rare Occurrence ◽  
Tissue Necrosis ◽  
Cytotoxic Effects ◽  
Direct Damage ◽  
Nicolau Syndrome ◽  
Syndrome Diagnosis ◽  
Pigmentary Pattern

Nicolau syndrome, also known as embolia cutis medicomentosa, is a rare complication characterized by tissue necrosis that occurs after injection of drugs. The exact pathogenesis is uncertain, but there are several hypotheses, including direct damage to the end artery and cytotoxic effects of the drug. Severe pain in the immediate postinjection 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. Etofenamate is a non-steroidal anti-inflammatory drug and a non-selective cyclooxygenase inhibitor. Cutaneous adverse findings caused by etofenamate are uncommon. Herein, we present a case with diagnosis of Nicolau syndrome due to etofenamate injection, which is a rare occurrence.

scholarly journals The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome)

2020 ◽  
Author(s):  
Tolga AKSAN ◽  
Uğur Kaan KALEM ◽  
Muhammed Beşir ÖZTÜRK ◽  
Cengiz ERTEKİN ◽  
Korhan ÖZKAN
Keyword(s):  
Surgical Treatment ◽  
Diclofenac Sodium ◽  
Tissue Necrosis ◽  
Nicolau Syndrome

scholarly journals Embolia Cutis Medicamentosa - A Case Report

2021 ◽  
Vol 10 (12) ◽  
pp. 910-911
Author(s):  
Shiliveri Sadhan Siddardha ◽  
Kolluru Karthik Raja ◽  
Amrutha Garikapati ◽  
Sameera Dronamraju ◽  
Sunil Kumar
Keyword(s):  
Clinical Course ◽  
Subcutaneous Tissue ◽  
Rare Complication ◽  
Arterial Lumen ◽  
Nicolau Syndrome ◽  
Bismuth Salts ◽  
Embolia Cutis Medicamentosa ◽  
Muscle Necrosis ◽  
Skin Discoloration ◽  
Vessel Thrombosis

Embolia cutis medicamentosa is a rare complication of intramuscular injury that leads to varying degrees of necrosis of the skin and subcutaneous tissue. In 1924, embolia cutis medicamentosa or Nicolau syndrome (NS) was first portrayed after an intragluteal injection of bismuth salts was given for the treatment of syphilis but it has now been documented with several drugs. (Murthy et al., 2007)1. According to one hypothesis, embolia cutis medicamentosa occurs when an intramuscular drug is accidentally injected into the arterial lumen or wall, leading to vessel thrombosis, subcutaneous tissue and muscle necrosis (Senel et al., 2010)2. Necrosis develops after hyperemia, skin discoloration usually associated with severe pain and wide inflammatory livedoid dermatitis and haemorrhagic patch at the injection site (Hamilton et al., 2008)3. Severe cases may take an immediate clinical course and anticipate to death.

Nicolau Syndrome Secondary to Subcutaneous Glatiramer Acetate Injection

2020 ◽  
pp. 153473462097314
Author(s):  
Caner Demircan ◽  
Neslihan Akdogan ◽  
Leyla Elmas
Keyword(s):  
Glatiramer Acetate ◽  
Rare Complication ◽  
Subcutaneous Administration ◽  
Ulcer Formation ◽  
Injectable Drugs ◽  
Nicolau Syndrome ◽  
Embolia Cutis Medicamentosa ◽  
History Of ◽  
Ulcerative Lesions ◽  
High Index Of Suspicion

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.

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

2017 ◽  
Vol 19 (3) ◽  
pp. 148-150 ◽  
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.

scholarly journals Nicolau syndrome due to diclofenac sodium (Voltaren®) injection: a case report

2014 ◽  
Vol 8 (1) ◽  
Author(s):  
İnci Kılıç ◽  
Füruzan Kaya ◽  
Ayşe T Özdemir ◽  
Tuğba Demirel ◽  
İlhami Çelik
Keyword(s):  
Case Report ◽  
Diclofenac Sodium ◽  
Nicolau Syndrome

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

2016 ◽  
Vol 15 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Carlos Alberto Araujo Chagas ◽  
Tulio Fabiano de Oliveira Leite ◽  
Lucas Alves Sarmento Pires
Keyword(s):  
Healthcare Professionals ◽  
Subcutaneous Tissue ◽  
Vascular Complication ◽  
Benzathine Penicillin ◽  
Intense Pain ◽  
Large Ulcer ◽  
Intramuscular Injections ◽  
Nicolau Syndrome ◽  
Left Buttock ◽  
Embolia Cutis Medicamentosa

Abstract We report on the case of a 40-year-old male who was admitted to the clinic with a large ulcer on his left buttock, 3 days after an intramuscular benzathine penicillin injection. The patient was diagnosed with Nicolau syndrome, a rare vascular complication in which a lesion develops after intramuscular injection. Symptoms are intense pain at the injection site, erythema, and livedoid dermatitis, which leads to necrosis of skin, subcutaneous tissue and muscle tissue. It was described by Nicolau after intramuscular injections of bismuth salt for syphillis therapy. Nicolau syndrome is rare, but its symptoms are devastating and healthcare professionals must be aware of this clinical entity, since intramuscular injections are common procedures for administration of drugs.

Nicolau Syndrome (Embolia Cutis Medicamentosa)

2018 ◽  
Vol 40 (3) ◽  
pp. 212-215 ◽  
Author(s):  
Dominic Tabor ◽  
Chandra G. Bertram ◽  
Andrew J. K. Williams ◽  
Marie E. Mathers ◽  
Asok Biswas
Keyword(s):  
Nicolau Syndrome ◽  
Embolia Cutis Medicamentosa

scholarly journals Diabetes Insipidus as a Complication of Wegener's Granulomatosis and Its Treatment with Biologic Agents

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Joanna Rosalind Cunnington ◽  
Ramesh Jois ◽  
Ivan Zammit ◽  
David Scott ◽  
John Isaacs
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Wegener’S Granulomatosis ◽  
Standard Treatment ◽  
Rare Complication ◽  
Wegener's Granulomatosis ◽  
Biologic Agents ◽  
Response To Treatment ◽  
Biologic Therapies ◽  
Patients With Diabetes

Wegener's granulomatosis of the pituitary gland resulting in diabetes insipidus is a rare complication of the disease. Standard treatment for Wegener's granulomatosis involves a combination of prednisolone and cylophosphamide, however biologic agents are now being used in refractory cases. We report three cases of patients with diabetes insipidus as a complication of Wegener's granulomatosis who were treated with biologic agents. All three cases showed clinical response to treatment with biologic agents including rituximab and alemtuzumab and two cases demonstrated improvement in pituitary gland abnormalities by MRI. Clinicians should be aware that diabetes insipidus can present as a complication of Wegener's granulomatosis and that biologic therapies may be effective in refractory cases.

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