Nicolau syndrome in a female patient following administration of intramuscular diclofenac injection: A case presentation

Abstract

Introduction: Nicolau syndrome is a rare condition involving tissue necrosis as an adverse reaction to intramuscular preparations.The aim of this paper is to provide an understanding of Nicolau syndrome and its management. Methods: Design: A case study approach was adopted. Setting: The study took place in a rural health centre in Jamaica WestIndies. An audit of the client’s medical record and interview with the client to obtain a history of the condition, followed by acomprehensive physical examination and laboratory testing. Synthesis of clinical and laboratory data as well as comparison offindings of similar cases done to confirm diagnosis. Results: Findings illustrate severe tissue necrosis with residual effect following intramuscular injection of diclofenac. Conclusions: The client had extensive tissue necrosis after receiving diclofenac injection which could be minimized with correctinjection technique and early management of adverse reaction. This study provides valuable insight into the need for registerednurses, clinical nurse specialists, advanced practice nurses and doctors, to be knowledgeable of injection techniques, recognitionof adverse effects of medications and the need for prompt specific management of adverse effects.