Abstract
Nicolau syndrome (NS), or embolia cutis medicamentosa, is a well-known but rare adverse effect of a still largely unidentified pathogenesis, observed primarily after the intramuscular administration of various drugs. NS is characterized by immediate excruciating pain, early pallor and erythema and oedema at the injection site, followed by cutaneous, subcutaneous and even muscular aseptic necrosis in a livedoid pattern. It is a potentially serious reaction that is little influenced by which drug is injected.
A case is reported of NS following a subcutaneous self-injection of etanercept for psoriasis and psoriatic arthritis. This case is remarkable because NS developed after subcutaneous and not after intramuscular drug administration, and because no cases of NS following the injection of tumour necrosis factor alpha inhibitors have been reported in the literature or in the World Health Organization adverse drug reactions database. Although not directly linked to the drug, the occurrence of NS has to be considered in patients receiving biological agents.
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References
Nicolau S. Dermite livédoide et gangréneuse de la fesse, consécutive aux injections intramusculaires, dans la syphilis. Ann Mal Vénér 1925; 20: 321–39
Luton K, Garcia C, Poletti E, et al. Nicolau syndrome: three cases and review. Int J Dermatol 2006; 45: 1326–8
Erkek E, Tuncez F, Sanli C, et al. Nicolau’s syndrome in a newborn caused by triple DTP (diphteria–tetanus–pertussis) vaccination. J Am Acad Dermatol 2006; 54: S241–2
Guarneri C, Polimeni G, Guarneri F, et al. Embolia cutis medicamentosa following thiocolchicoside injection. J Eur Acad Dermatol Venereol 2008; 22: 1005–6
Harde V, Schwarz T. Embolia cutis medicamentosa following subcutaneous injection of glatiramer acetate. J Dtsch Dermatol Ges 2007; 5: 1122–3
Enbrel® (etanercept): prescribing information. Amgen/Wyeth, 2009. Available from http://www.enbrel.com/pdf/enbrel_pi.pdf
Lee HH, Song IH, Friedrich M, et al. Cutaneous side-effects in patients with rheumatic diseases during application of tumour necrosis factor-a antagonists. Br J Dermatol 2007; 156: 486–91
Acknowledgments
The authors would like to thank Stephanie Blick of inScience Communications who provided assistance with English-language editing. This assistance was funded by Pfizer. The authors have no conflicts of interest that are directly relevant to the content of this case report.
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Guarneri, C., Polimeni, G. Nicolau Syndrome Following Etanercept Administration. AM J Clin Dermatol 11 (Suppl 1), 51–52 (2010). https://doi.org/10.2165/1153426-S0-000000000-00000
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DOI: https://doi.org/10.2165/1153426-S0-000000000-00000