Nicolau Syndrome Following Intramuscular Diclofenac Injection

Seong Jun Ahn; Suk Woong Kang; Bu Hwan Kim; Moo Ho Song; Seong Ho Yoo; Young Jun Kim; Dong Hwan Kim

doi:10.4055/jkoa.2015.50.4.333

Journal List > J Korean Orthop Assoc > v.50(4) > 1013389

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ahn, Kang, Kim, Song, Yoo, Kim, and Kim: Nicolau Syndrome Following Intramuscular Diclofenac Injection

Case Report

Journal of the Korean Orthopaedic Association 2015; 50(4): 333-336.

Published online: 24 August 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.4.333

Nicolau Syndrome Following Intramuscular Diclofenac Injection

Seong Jun Ahn, M.D., Suk Woong Kang, M.D., Bu Hwan Kim, M.D., Moo Ho Song, M.D., Seong Ho Yoo, M.D., Young Jun Kim, M.D., Dong Hwan Kim, M.D.

Department of Orthopaedic Surgery, Daedong Hospital, Busan, Korea.

Correspondence to: Suk Woong Kang, M.D. Department of Orthopaedic Surgery, Daedong Hospital, 187 Chungnyeol-daero, Dongrae-gu, Busan 47737, Korea. TEL: +82-51-550-9396, FAX: +82-51-553-7575, redmaniak@naver.com

Received 10 November 2014 Revised 24 February 2015 Accepted 24 February 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nicolau syndrome is a rare complication causing severe pain and tissue necrosis after intramuscular injection. In Korea, the Korea Dermatological Association has reported 12 cases, and some severe cases required surgical treatment. Most cases have been related to the administration of a variety of drugs, including nonsteroidal anti-inflammatory drugs, corticosteroids, and antibiotics. We present two patients who developed this complication, 1 case of typical Nicolau syndrome and 1 case of atypical Nicolau syndrome.

Keywords: intramuscular injection, nonsteroidal anti-inflammatory drugs (NSAIDs), Nicolau syndrome

Figures and Tables

Figure 1

(A) Large necrotic skin patch measuring 10×10 cm over the left buttock. (B) T2-weighted magnetic resonance imaging: diffuse high signal intensity in the left gluteal muscle.

Figure 2

(A) Diffuse livedoid pattern in the left buttock. (B) T2-weighted magnetic resonance imaging: pelvis showing swelling and abnormal signal in left gluteal muscles.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

1. Nicolau S. Dermite Livedoide et Gangreneuse de la Fesse, Consecutive aux Injections Intramusculaires, dans la Syphilis. A Propos d'un Cas d'Embolie Arterielle Bismuthique. Ann Mal Vener. 1925; 20:321–339.

2. Go JW, Kim SH, Ro BI, Oh HE, Cho HK. Embolia cutis medicamentosa following intramuscular injection of diclofenac. Korean J Dermatol. 2010; 48:786–789.

3. Lie C, Leung F, Chow SP. Nicolau syndrome following intramuscular diclofenac administration: a case report. J Orthop Surg (Hong Kong). 2006; 14:104–107.

4. De Sousa R, Dang A, Rataboli PV. Nicolau syndrome following intramuscular benzathine penicillin. J Postgrad Med. 2008; 54:332–334.

5. Faucher L, Marcoux D. What syndrome is this? Nicolau syndrome. Pediatr Dermatol. 1995; 12:187–190.

6. McGee AM, Davison PM. Skin necrosis following injection of non-steroidal anti-inflammatory drug. Br J Anaesth. 2002; 88:139–140.

7. Duque FLV, Chagas CAA. Intramuscular accident with drug injection in the deltoid muscle: local and distant lesions, review of 32 cases. J Vasc Bras. 2009; 8:238.

8. Cockshott WP, Thompson GT, Howlett LJ, Seeley ET. Intramuscular or intralipomatous injections? N Engl J Med. 1982; 5. 307:356–358.

9. Kim DH, Oh GN, Kim JY, et al. Successful treatment of nicolau syndrome with platelet rich plasma. Korean J Dermatol. 2013; 51:69–71.

10. Cherasse A, Kahn MF, Mistrih R, Maillard H, Strauss J, Tavernier C. Nicolau's syndrome after local glucocorticoid injection. Joint Bone Spine. 2003; 70:390–392.

TOOLS

Similar articles