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A Rare Case of Nicolau’s Syndrome (Embolia Cutis Medicamentosa) Following Intramuscular Diclofenac Sodium Injection in a Young Adult

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Abstract

Nicolau syndrome (embolia cutis medicamentosa) is a condition where we see variable degrees of tissue necrosis including the skin and deeper tissues, due to an iatrogenic cause, intramuscular, subcutaneous, intra-articular injections, could be some of them. It occurs due to intravascular inoculation leading to crystal embolization causing thrombotic occlusion, vasospasm, and marked inflammation and surrounding necrosis. Here, we present a case of a 35-year-old gentleman who presented to us with bluish-purple discoloration of the skin followed by a necrotic patch and ulceration with multiple hyperpigmented spots over the back and lower limb post intramuscular diclofenac sodium injection. Routine investigation showed neutrophilia and thrombocytosis with increased creatinine. A diagnosis of Nicolau’s syndrome (embolia cutis medicamentosa) was made clinically, which was confirmed by histopathology following biopsy. Adequate surgical debridement and a combination therapy of analgesics, intravenous antibiotics, intravenous anticoagulants, and vasoactive therapy were administered. Split thickness skin grafting was done once the wound was healthy with rich granulation tissue, after 4 weeks of index surgery in this case. Patient recovered uneventfully.

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Authors and Affiliations

  1. Department Of General Surgery, BLDE (DU) Shri B.M.Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India

    M. S. Kotennavar, Aravind V. Patil, Pradeep Jaju & Narendra Ballal

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  1. M. S. Kotennavar
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  2. Aravind V. Patil
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  3. Pradeep Jaju
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  4. Narendra Ballal
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Correspondence to Narendra Ballal.

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Kotennavar, M.S., Patil, A.V., Jaju, P. et al. A Rare Case of Nicolau’s Syndrome (Embolia Cutis Medicamentosa) Following Intramuscular Diclofenac Sodium Injection in a Young Adult. Indian J Surg (2024). https://doi.org/10.1007/s12262-023-04011-8

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  • DOI: https://doi.org/10.1007/s12262-023-04011-8

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