Abstract
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.
Highlights
Nicolau syndrome is a rare complication caused by intramuscular injection of various medications[1]
It has been shown that non-steroidal anti-inflammatory drug (NSAID) play a key role in the pathogenesis of vascular spasm induction and local circulation blockage, inhibiting the COX enzyme and prostaglandin synthesis[7]
These drugs have a central role in inducing vascular spasm and blocking local circulation, inhibiting the COX enzyme and prostaglandin synthesis in the pathogenesis of this syndrome[7]
Summary
Nicolau syndrome is a rare complication caused by intramuscular injection of various medications[1]. We present a rare case of Nicolau syndrome after etofenamate injection. Case report An 81-year-old woman was admitted to our clinic with a painful necrotic ulcer in the left gluteal region. Her medical history, which was non-specific, except for back pain, revealed an intramuscular etofenamate injection (1000 mg), due to back pain, 15 days before. Dermatological examination revealed a painful ulcerous plaque with a black necrotic crest in the lateral part of the left gluteal region. This ulcerous plaque appeared indurated and erythematous in its surrounding (Figure 1). After surgical debridement by the plastic surgeon, and continuation of local wound care (as above), the ulcer lesion was completely regressed, leaving an atrophic scar after one month (Figure 2)
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