NICOLAU SYNDROME IN A CHILD FOLLOWING IV CLINDAMYCIN INJECTION-DECODING THE PURPLE PUZZLER

2021 ◽  
pp. 51-52
Author(s):  
Anusree Krishna Mandal ◽  
Jadab Kumar Jana ◽  
Soumya Gayen
Keyword(s):  
Literature Review ◽  
Injection Site ◽  
Local Anesthetics ◽  
Skin Necrosis ◽  
Rare Complication ◽  
Left Forearm ◽  
Intense Pain ◽  
Intramuscular Injections ◽  
Nicolau Syndrome ◽  
Muscle Necrosis

Nicolau syndrome is a rare complication of intramuscular injections caused by various drugs that present with intense pain and induration at the injection site. It is characterized by local aseptic skin necrosis and rarely, muscle necrosis on the injection site. It has rarely been reported to occur after intramuscular injections of anti-inammatory drugs, corticosteroids, local anesthetics, penicillin and interferon. Our literature review revealed no cases of Nicolau syndrome following intravenous (IV) clindamycin injections. Herein, we report a case of Nicolau syndrome that occurred after IV clindamycin injection in the left forearm of a 1.5-year child, that was notable because of the uniqueness of the syndrome coupled with the fact that it has not previously been reported after intravenous clindamycin injection.

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.

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.

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.

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 and literature review: Horner syndrome subsequent to endoscopic thyroid surgery

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Min ◽  
Hang Chen ◽  
Xing Wang ◽  
Ying Huang ◽  
Guobing Yin
Keyword(s):  
Literature Review ◽  
Thyroid Surgery ◽  
Thyroid Nodules ◽  
Rare Complication ◽  
Needle Aspiration ◽  
Horner Syndrome ◽  
Central Lymph Node Dissection ◽  
Thyroid Microcarcinoma ◽  
Endoscopic Thyroid Surgery ◽  
Central Lymph

Abstract Background Horner syndrome (HS), mainly characterized by symptoms including ptosis, miosis, and anhidrosis on the affected face, is a condition that is well documented but rarely reported as a postoperative complication of thyroidectomy, particularly in endoscopic thyroid surgery (ETS). We hereby report a case of HS due to ETS with a brief literature review on this topic. Case presentation A 31-year-old female was admitted to our hospital with an unexpected physical examination finding of two thyroid nodules that were hypoechoic, had an irregular shape, and exhibited calcification. Subsequently, the results of a fine-needle aspiration (FNA) biopsy from the thyroid nodules and BRAFV600E mutation further confirmed the malignancy of these nodules. Thus, total thyroidectomy combined with central lymph node dissection (CLND) by ETS via the bilateral axillo-breast approach was performed on this patient. Histology confirmed the diagnosis of papillary thyroid microcarcinoma (PTMC) concurrent with Hashimoto’s thyroiditis (HT). However, this patient developed HS with ptosis in her left eye on postoperative day 3. All symptoms gradually resolved before the 3-month follow-up. Conclusion HS subsequent to ETS is a rare complication. Thus, standardized and appropriate operative procedures, as well as subtle manipulation, are essential in preventing and reducing the occurrence of HS. In addition, the early diagnosis and management of this rare complication are also important for a favorable outcome.

Cooccurrence of Two Different Genetic Diseases: A Case of Valproic Acid Hepatotoxicity in Nicolaides–Baraitser Syndrome (SMARCA2 Mutation)—Due to a POLG1-Related Effect?

2019 ◽  
Vol 51 (01) ◽  
pp. 049-052
Author(s):  
Benedikt Hofmeister ◽  
Celina von Stülpnagel ◽  
Steffen Berweck ◽  
Angela Abicht ◽  
Gerhard Kluger ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Literature Review ◽  
Rare Disease ◽  
Clinical Features ◽  
Rare Diseases ◽  
Rare Complication ◽  
Genetic Diseases ◽  
Related Effect ◽  
Higher Sensitivity ◽  
Polg1 Mutation

AbstractNicolaides–Baraitser syndrome (NCBRS) is a rare disease caused by a mutation in the SMARCA2 gene. Clinical features include craniofacial dysmorphia and abnormalities of the limbs, as well as intellectual disorder and often epilepsy. Hepatotoxicity is a rare complication of the therapy with valproic acid (VPA) and a mutation of the polymerase γ (POLG) might lead to a higher sensitivity for liver hepatotoxicity. We present a patient with the coincidence of two rare diseases, the NCBRS and additionally a POLG1 mutation in combination with a liver hepatotoxicity. The co-occurrence in children for two different genetic diseases is discussed with the help of literature review.

scholarly journals Gastro- or Duodenojejunostomy Leaks After Pancreatoduodenectomy: Single Center Experience and Narrative Literature Review

2021 ◽  
Author(s):  
Knut Jørgen Labori ◽  
Tore Tholfsen ◽  
Sheraz Yaqub ◽  
Kristoffer Lassen ◽  
Dyre Kleive ◽  
...  
Keyword(s):  
Literature Review ◽  
Rare Complication ◽  
Length Of Hospital Stay ◽  
Single Center ◽  
Unsuccessful Attempt ◽  
Feeding Jejunostomy ◽  
Single Center Experience ◽  
Endoscopic Gastrostomy ◽  
Narrative Literature ◽  
Narrative Literature Review

Abstract Background and Methods Gastro- or duodenojejunostomy leaks after pancreatoduodenectomy is rare. This study aims to analyze the incidence, management, and outcome of gastro- or duodenojejunostomy leaks after pancreatoduodenectomy based on a single center experience from 2004 to 2020 with a narrative literature review. Results Of a total of 1494 pancreatoduodenectomies, eight patients with gastrojejunostomy (n=1) or duodenojejunostomy (n=7) leak were identified from the institutional pancreatic database. All leaks were treated operatively. In two patients dismantling of the duodenojejunostomy, distal gastrectomy, and closure of the pyloric and jejunal side, a percutaneous endoscopic gastrostomy and a feeding jejunostomy ultimately had to be performed after an unsuccessful attempt of gastrojejunostomy and suture of the duodenojejunostomy, respectively. The literature search revealed three more studies specifically addressing this complication after pancreatoduodenectomy (36 patients of a total of 4739 pancreatoduodenectomies). Based on an analysis of the current study and the literature review, the overall incidence of gastro- or duodenojejunostomy leaks after pancreatoduodenectomy was 0.71 % (44/6233 pancreatoduodenectomies). The occurrence of a gastro- or duodenojejunostomy leak was associated with a concomitant postoperative pancreatic fistula in 50 % of the cases, an increased length of hospital stay, and a mortality rate of 15.9 %. Surgical treatment was performed in 84 % of the cases. Conclusion Gastro- or duodenojejunostomy leak is a rare complication after pancreatoduodenectomy. Prompt diagnosis and early repair is important. In most cases, a surgical intervention is necessary for a good outcome. Under salvage conditions, a bailout strategy may be to temporarily dismantle the gastro- or duodenojejunal anastomosis.

Pharmacokinetics, safety, and tolerability of four 28-day cycle intramuscular injections for risperidone-ISM 75 mg in patients with schizophrenia: A phase-2 randomized study (PRISMA-2)

2016 ◽  
Vol 33 (S1) ◽  
pp. s240-s241 ◽  
Author(s):  
L. Anta ◽  
J. Llaudó ◽  
I. Ayani ◽  
B. Gorostidi ◽  
M. Monreal ◽  
...  
Keyword(s):  
Injection Site ◽  
Drug Administration ◽  
Randomized Study ◽  
Deltoid Muscle ◽  
Study Medication ◽  
Open Label ◽  
Active Moiety ◽  
Intramuscular Injections ◽  
Competing Interest ◽  
Long Acting

IntroductionRisperidone-ISM is a new long acting intramuscular formulation of risperidone, for monthly administration without oral supplementation.ObjectiveTo characterize the pharmacokinetic of risperidone over multiple intramuscular injections in patients with schizophrenia.MethodA multicenter, open label, two-arm, parallel design clinical trial was performed. Each patient received 4 intramuscular injections of 75 mg of risperidone-ISM in either, gluteal or deltoid muscle at 28-day intervals.ResultsA total of 70 patients were randomized, 67 received at least one dose of study medication. Preliminary data show that mean Cmax of the active moiety was achieved 24-48 hours (Tmax) after each administration and ranged over four consecutive doses from 39.6-53.2 ng/mL and 54.1-61 ng/mL, when given in gluteal or deltoid, respectively. All subjects achieved therapeutic levels (> 7.5 ng/mL for the active moiety) between 2-8 hours after drug administration. The mean concentrations were maintained above therapeutic levels throughout the 4-week dosing period. No significance changes across the study were observed, either on Positive and Negative Syndrome Scale or Extrapyramidal Symptoms Scale. Overall, 63 subjects (94%) experienced at least 1 Treatment Emergent Adverse Event (TEAE) during the study. One serious TEAE (dystonia) was related to study treatment. One death not related to study medication was informed. The most frequently reported TEAEs were hyperprolactinaemia (57.7%) and injection site pain (32.8%).ConclusionsRisperidone-ISM achieved therapeutic levels from the first hours after drug administration and provided a sustained release throughout the 4-weeks dosing period over multiple intramuscular injections independently of the injection site. Risperidone-ISM was found to be safe and well tolerated.Disclosure of interestThe authors have not supplied their declaration of competing interest.

On the issue of damage to the nerve trunks during intramuscular injections

1937 ◽  
Vol 33 (5) ◽  
pp. 590-596
Author(s):  
Sh. V. Bikchurin ◽  
E. I. Eselevich
Keyword(s):  
Sciatic Nerve ◽  
Injection Site ◽  
Peripheral Nerves ◽  
Intramuscular Injections

Cases of damage to the nerve trunks during intramuscular injections are now quite rare, since they can be avoided by strictly observing the rules for choosing the injection site. In the old manuals of Oppenheim and Lewandowski and in the newest manuals of Kraus and Brugsch (Toby Cohn), injections of various medications are indicated as the etiological moment of damage to the sciatic nerve. Injections of quinine and its compounds in the treatment of malaria, as well as injections of bioquinol, in some cases cause injury to peripheral nerves.

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