Abstract
IntroductionNicolau syndrome, also known as livedo-like dermatitis or embolia cutis medicamentosa, is a rare complication following the intramuscular or intra-articular injection of various drugs.Case presentationIn our case report we report the case of a 45-year-old Turkish woman who developed Nicolau syndrome after an intramuscular injection in her right gluteal region of single-dose diclofenac sodium to treat a headache. A culture taken from the ulcer showed growth of methicillin-sensitive Staphylococcus aureus on the 10th day. The secondary staphylococcal infection was treated effectively with intravascular ampicillin-sulbactam (4×1.5g/day). She was treated with surgical debridement, sterile dressings and analgesics. The ulcer healed completely within 12 weeks with scarring.ConclusionsAlthough Nicolau syndrome develops very rarely, it is an important cause for morbidity. It is an iatrogenic condition, treated mostly by health care workers. Thus, although it appears to be a very simple procedure for a health care worker, care must be taken during intramuscular injections. Although diclofenac sodium is a widely used non-steroidal anti-inflammatory drug, Nicolau syndrome following intramuscular diclofenac sodium injection has rarely been reported in the published literature. The application of a cold compress was considered to be an aggravating factor in our patient. This case highlights the need for awareness about this condition and the need to exercise utmost care during the administration of any parenteral injections by health workers.
Highlights
Nicolau syndrome, known as livedo-like dermatitis or embolia cutis medicamentosa, is a rare complication following the intramuscular or intra-articular injection of various drugs.Case presentation: In our case report we report the case of a 45-year-old Turkish woman who developed Nicolau syndrome after an intramuscular injection in her right gluteal region of single-dose diclofenac sodium to treat a headache
Nicolau syndrome develops very rarely, it is an important cause for morbidity
It is an iatrogenic condition, treated mostly by health care workers. It appears to be a very simple procedure for a health care worker, care must be taken during intramuscular injections
Summary
Health care personnel should be aware that NS, characterized by pain, skin discoloration, and necrosis, can be observed following an injection of diclofenac sodium, an NSAID. As the exact etiopathogenesis of this syndrome is not known, there is no standard guideline for its management. Wound debridement in early stages, and corrective plastic surgery in late stages are the mainstay in management. Clinicians should be aware of this complication and use proper injection procedures. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Authors’ contributions İK and FK were involved in the diagnosis, findings, and interpretation of the case. İK, AÖ and TD wrote the manuscript. İÇ was the mentor in all processes and determined the pattern of case presentation. All authors read and approved the final manuscript
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