Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.008315
Jornal Vascular Brasileiro
Case Report

Post-injection embolia cutis medicamentosa – Nicolau Syndrome: case report and literature review

Embolia cutis medicamentosa pós-injeção – Síndrome de Nicolau: relato de caso e revisão de literatura

Carlos Alberto Araujo Chagas; Tulio Fabiano de Oliveira Leite; Lucas Alves Sarmento Pires

Downloads: 6
Views: 1925

Abstract

Abstract We report on the case of a 40-year-old male who was admitted to the clinic with a large ulcer on his left buttock, 3 days after an intramuscular benzathine penicillin injection. The patient was diagnosed with Nicolau syndrome, a rare vascular complication in which a lesion develops after intramuscular injection. Symptoms are intense pain at the injection site, erythema, and livedoid dermatitis, which leads to necrosis of skin, subcutaneous tissue and muscle tissue. It was described by Nicolau after intramuscular injections of bismuth salt for syphillis therapy. Nicolau syndrome is rare, but its symptoms are devastating and healthcare professionals must be aware of this clinical entity, since intramuscular injections are common procedures for administration of drugs.

Keywords

Nicolau syndrome, injections, intramuscular, ulcer

Resumo

Resumo Relatamos o caso de um homem de 40 anos apresentando uma grande úlcera na nádega esquerda 3 dias após receber injeção intramuscular de penicilina benzatina. O paciente foi diagnosticado com síndrome de Nicolau, uma rara complicação vascular com lesão após injeções intramusculares. Os sintomas incluem dor intensa no local da injeção, eritema e dermatite livedoide, o que leva a necrose da pele, do tecido subcutâneo e do tecido muscular. Foi descrita por Nicolau após injeções intramusculares de sal de bismuto para o tratamento de sífilis. A síndrome de Nicolau é incomum, mas seus sintomas são devastadores. Portanto, os profissionais de saúde precisam conhecer essa entidade clínica, uma vez que as injeções intramusculares são procedimentos comuns para a administração de drogas.

Palavras-chave

síndrome de Nicolau, injeções intramusculares, úlcera

References

Dadaci M, Altuntas Z, Ince B, Bilgen F, Tufekci O, Poyraz N. Nicolau Syndrome after intramuscular injection of non-steroidal anti-inflammatory drugs (NSAID). Bosn J Basic Med Sci. 2015;15(1):57-60.

Pérez AP, Blanco VP, Fernández RS. Síndrome de Nicolau tras la administración de acetato de glatirámero. Neurologia. 2013;28(7):448-9.

Lopes L, Filipe P, Alves A, Guerreiro F, Pires S. Nicolau syndrome after benzathine penicillin treated with hyperbaric oxygen therapy. Int J Dermatol. 2015;54(4):e103-6.

Senel E. Nicolau syndrome as an avoidable complication. J Family Community Med. 2012;19(1):52-3.

Kılıç İ, Kaya F, Özdemir AT, Demirel T, Çelik İ. Nicolau syndrome due to diclofenac sodium (Voltaren®) injection a case report. J Med Case Reports. 2014;8:404.

Bégin P, Anne DR. Nicolau syndrome may be caused by intravascular vaccine injection. Vaccine. 2012;30(11):2035-6.

Kim SK, Kim TH, Lee KC. Nicolau syndrome after intramuscular injection: 3 cases. Arch Plast Surg. 2012;39(3):249-52.

Almudimeegh A, Pelletier FL, Dupin N. Nicolau syndrome secondary to subcutaneous Bortezomib injection. J Eur Acad Dermatol Venereol. 2014;30(2):348-50.

Duque FL, Chagas CA. Acidente por injeção medicamentosa no músculo deltoide: lesões locais e à distância, revisão de 32 casos. J Vasc Bras. 2009;8(3):238-46.

Korkomaz J, Maatouk I, Moutran R, Hélou J. Nicolau livedoid dermatitis occurring after sclerotherapy. Vasc Med. 2014;19(5):415-6.

Noaparast M, Mirsharifi R, Elyasinia F, Parsaei R, Kondori H, Farifteh A. Nicolau Syndrome after Intramuscular Benzathine Penicillin Injection. Iran J Med Sci. 2014;39(6):577-9.

Bellot B, Bonnet C, Retornaz K. Complication d’une injection intramusculaire ou syndrome de Nicolau. Arch Pediatr. 2014;21(4):377-80.

Ergul Y, Soydemir D, Tastan Y, Omeroglu RE. Does early hyperbaric oxygen therapy prevent extremity necrosis in Nicolau syndrome?. Pediatr Int. 2012;54(3):e15-8.

Perli D, Martone C, Rapose A. Naltrexone-induced Nicolau syndrome masquerading as cutaneous abscess. BMJ Case Rep. 2012;2012:14.

Masthan Saheb D, Madhav S, Reddy KC, Lakshmi S, Prabha R, Anandam K. Nicolau syndrome. Indian J Dermatol Venereol Leprol. 2002;68(1):45-6.

Deissert S. Embolia cuits medicamentosa (Nicolau syndrome) nach intra aricurarer injektion. Hautarzt. 1999:50214-6.

McKinney C, Sharma N, Jerath RS. Livedoid dermatitis (Nicolau Syndrome) following intra-articular glucocorticoid injection. J Clin Rheumatol. 2014;20(6):339-40.

Perissé R, Fernandes AD, Monteiro A, Cortes JC, Meirelles ML, Azambuja M. Acidentes vasculares por injeção. J Bras Med. 1967:13213-8.

Andrade P, Pereira N, Brites MM, Gonçalo M, Figueiredo A. Nicolau livedoid dermatitis following intramuscular benzathine penicillin injection. Dermatol Online J. 2010;16(11):11.

Kim DH, Ahn HH, Kye YC, Choi JE. Nicolau syndrome involving whole ipsilateral limb induced by intramuscular administration of gentamycin. Indian J Dermatol Venereol Leprol. 2014;80(1):96.

Zaragoza J, Delaplace M, Benamara M, Estève E. A rare side effect of mesotherapy: Nicolau syndrome. Ann Dermatol Venereol. 2013;140(11):713-7.

Nirmal B, Segu SS, Sacchidanand SA, Deshpande P. Nicolau syndrome following sclerotherapy for pyogenic granuloma. Indian J Dermatol Venereol Leprol. 2014;80(5):484.

Nayci S, Gurel MS. Nicolau syndrome following intramuscular diclofenac injection. Indian Dermatol Online J. 2013;4(2):152-3.

Silva AM, Loureiro TF, Ton A, Agrizzi BL. Síndrome de Nicolau de desenvolvimento tardio - relato de caso. An Bras Dermatol. 2011;86(1):157-9.

Senel E, Ada S, Güleç AT, Caglar B. Nicolau syndrome aggravated by cold application after i.m. diclofenac. J Dermatol. 2008;35(1):18-20.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5de6c5490e8825fa36e3e9d1 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections