Year 2019 Vol. 27 No 4

CASE REPORTS

A.L. PETRUSHIN, A.V. PRYALUHINA, A.A. SIDOROV

NICOLAU SINDROME

Karpogory Central District Hospital,
The Russian Federation

The objective of this study is the clinical case of the Nicolau syndrome demonstration and a brief review of the literature on its diagnosis and treatment. Nicolau syndrome is a rare post-injection complication, characterized by the development of ischemic necrosis of the skin, subcutaneous tissue, and in some cases, muscle tissue, in the injection zone. The description of the clinical case is presented, in which after intramuscular injection of diclofenac the tissue and subcutaneous tissue of the gluteal region necrosis developed, requiring necrectomy and replacement of a soft tissue defect. The most common cause of Nicolau syndrome development is the non-steroidal anti-inflammatory drugs injections. Predisposing factors are overweight and accidental subcutaneous instead of intramuscular injection. Among the causes of development, most authors call angiospasm, small and medium artery embolism, and subsequent ischemia. Diagnosis based on clinical signs: the appearance immediately after injection of a clearly delineated ischemia patch, followed by the development of necrosis. In the early stages, conservative management, including anticoagulants, disaggregants and corticosteroids, is possible. In the presence of necrosis, their excision and replacement of the defect are indicated. Plastics with local tissues coverage can replace the extensive defects without large scars formation. Prevention of the Nicolau syndrome mainly consists of accidental subcutaneous and intravascular drug administration preventing.
The presented clinical case and a review of the literature suggest that Nicolau syndrome is a rare post-injection complication with unclear etiology and pathogenesis. A typical manifestation of this syndrome is necrosis of soft tissues in the injection site. The local skin-fascial flaps using is the effective method of the defects coverage after debridement necrectomy.

Keywords: Nicolau syndrome, livedoid dermatitis, skin necrosis, intramuscular injection, post-injection complications
p. 469-474 of the original issue
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Address for correspondence:
164600, The Russian Federation,
Arkhangelsk region, Karpogory, Lenin Str., 47,
Karpogory Central District Hospital,
Surgery Unit,
Tel.mob. +7 921076-73-29,
e-mail: petrushin.59@mail.ru
Alexander L. Petrushin
Information about the authors:
Petrushin Alexander L., PhD, Head of the Surgery Unit, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-3246-7452
Pryaluhina Anastasia V., Gynecologist, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-9801-5782
Sidorov Alexey A., Surgeon, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-1345-6352
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