Nicolau syndrome: A rarely seen iatrogenic fatal cutaneous reaction following intramuscular diclofenac injection

Abstract

Nicolau syndrome, also known as embolia cutis medicamentosa or livedoid dermatitis, is a rare cutaneous adverse drug reaction seen at the site of injection of some particular drugs. It was first reported by Freudenthal in 1924 and Nicolau in 1925 as an adverse effect of bismuth salts used in syphilis. Typically, this syndrome is clinically manifested by intense burning or stabbing pain at the site of injection and retiform hemorrhagic patches with or without vesiculations and ulceration with a variable degree of tissue necrosis. To the best of our knowledge, <50 cases of Nicolau syndrome have been reported in medical literature which occurred following intramuscular administration of diclofenac sodium. Here, we report a 26-year-old female typically presenting with pathognomic signs and symptoms of NS after taking intramuscular injection of diclofenac.