Nicolau syndrome

Authors

  • Jimena Lorena Torchetti Professor Alejandro Posadas National Hospital, El Palomar, Province of Buenos Aires, Argentina
  • Geraldina Rosa Rodríguez Rivello Professor Alejandro Posadas National Hospital, El Palomar, Province of Buenos Aires, Argentina
  • Tatiana Carmen Alfaro Professor Alejandro Posadas National Hospital, El Palomar, Province of Buenos Aires, Argentina
  • Patricia Silvia Della Giovanna Professor Alejandro Posadas National Hospital, El Palomar, Province of Buenos Aires, Argentina

DOI:

https://doi.org/10.47196/da.v29i1.2320

Keywords:

Nicolau syndrome, iatrogenic, retiform purpura, penicillin

Abstract

Nicolau syndrome (embolism cutis medicinala) represents a rare and probably underdiagnosed iatrogenic entity, first described in 1924 after the intramuscular application of bismuth salts for the treatment of syphilis. The pathophysiology is not fully elucidated, although there are several theories that describe ischemia as a common final mechanism. Regarding the cutaneous manifestations, the most frequent form observed is a violaceous livedoid plaque, which can evolve to skin necrosis at the injection site. The diagnosis is mainly clinical, associated with the history of drug application. The treatment depends on the severity of the clinical manifestations.

In this work we report a case of Nicolau syndrome due to intramuscular application of penicillin.

Author Biographies

Jimena Lorena Torchetti, Professor Alejandro Posadas National Hospital, El Palomar, Province of Buenos Aires, Argentina

Chief Resident of Dermatology

Geraldina Rosa Rodríguez Rivello, Professor Alejandro Posadas National Hospital, El Palomar, Province of Buenos Aires, Argentina

Staff Physician Specialist in Dermatology

Tatiana Carmen Alfaro, Professor Alejandro Posadas National Hospital, El Palomar, Province of Buenos Aires, Argentina

Pathologist, Pathological Anatomy Service

Patricia Silvia Della Giovanna, Professor Alejandro Posadas National Hospital, El Palomar, Province of Buenos Aires, Argentina

Head of the Dermatology Service

 

References

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II. Gammel JA. Local accidents following the intramuscular administration of salts of heavy metals: report of two cases of embolia cutis medicamentosa. Arch Derm Syphilol. 1928;18:210-223.

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IV. Marangi GF, Gigliofiorito P, Toto V, Langella M, et ál. Three cases of embolia cutis medicamentosa (Nicolau’s syndrome). J Dermatol. 2010;37:488-492.

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VI. Kim K-K. Nicolau syndrome: A literature review. World J Dermatol. 2015;4:103-107.

VII. Shelley BP, Prasad P, Manjunath MM, Chakraborti S. hyperacute paraplegia and neurovascular (immuno vasculotoxic) catastrophe of Nicolau syndrome: primum non nocere. Ann Indian Acad Neurol. 2019;22:104-108.

VIII. Malik MH, Heaton H, Sloan B. Nicolau syndrome following intramuscular naltrexone injection. Dermatol Online J. 2020;26.

IX. Noaparast M, Mirsharifi R, Elyasinia F, Parsaei R, et ál. Nicolau syndrome after intramuscular benzathine penicillin injection. Iran J Med Sci. 2014;39:577-579.

X. Jung Kim H, Hyun Park S. Sciatic nerve injection injury. J Int Med Res. 2014;42:887-897.

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Published

2023-04-21

Issue

Vol. 29 No. 1 (2023): January/April 2023

Section

Clinical Cases

License

Copyright (c) 2023 on behalf of the authors. Reproduction rights: Argentine Society of Dermatology

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

El/los autor/es tranfieren todos los derechos de autor del manuscrito arriba mencionado a Dermatología Argentina en el caso de que el trabajo sea publicado. El/los autor/es declaran que el artículo es original, que no infringe ningún derecho de propiedad intelectual u otros derechos de terceros, que no se encuentra bajo consideración de otra revista y que no ha sido previamente publicado.

 

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