PLASTİK REKONSTRÜKTİF
EDİTÖRE MEKTUP
LETTER TO THE EDITOR
ve ESTETİK CERRAHİ DERGİSİ TÜRKwww.turkplastsurg.org
90Geliş Tarihi : xx.xx.2015 Kabul Tarihi : xx.xx.2015
Cilt 23 / Sayı 2 2015
Dear Editor;
Nicolau syndrome was described by Nicolau with an intramuscular injection of Bismuth salt for the tre- atment of syphilis.1 Severe pain at injection area and discoloration after the injection are the main features of this syndrome. This iatrogenic complication may be the result of intravenous, intramuscular, intraarti- cular or subcutaneous injections.2-6 The most terrible symptom is paralysis of the lower extremities because of sciatic nerve ischemia.7 The author’s report is a male patient who was referred to our clinic with necrosis on his buttock.
A 56-years-old male patient received to our clinic with an 8x3 cm necrosis on his right buttock due to intramuscular injection of diclofenac at another center (Figure 1). He was treated with diclofenac because of muscle pains on his back. Local cold or hot application was not concerned by the patient. His medical history was taken and routine blood tests were performed. Sur- gical debridement was done with local anesthesia and he was followed with moist dressings daily. At the end of the 15th day the wound was healed with unfavorable scar.
Nicolau syndrome (embolia cutis medicamentosa) is an iatrogenic syndrome that starts with severe pain at the injection site and then discoloration of the effected skin. The color change can be turn into different thick- ness necrosis.
The etiopathogenesis of the disease is not clarified yet. But several hypotheses have been suggested for this unfortunate complication. Vasospasm due to need- le prick, embolisation of the injected drug is some of these hypotheses.8
The diagnosis of the disease is based on only physi- cal examination. Biopsy is consists of classic tissue nec- rosis. Ultrasonography or magnetic resonance can be
helpful for extension of the necrotic tissues.9
Early treatment is important for avoiding the extra necrosis. Cooling the area can aggravate the symptoms.
Hyperbaric oxygen, thrombolytic agents, intralesional corticosteroids are just a few of the treatment options.9 We have done surgical debridement of the necrosis. We believe that early cleaning of the necrotic tissues can promote wound healing and reduce inflammation.
Nicolau syndrome is a rare complication of drug in- jection procedures. This syndrome could be considered in patients presenting with tissue necrosis.
Kırıkkale Üniversitesi Tıp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi AD, KıRıKKALE
Elif Sarı
NICOLaU SyNDROME DUE TO INTRaMUSCULaR INjECTION Of DICLOfENaC İNTRaMüSKüLER DİKLOfENaK ENjEKSİyONUNa bağLI NİCOLaU SENDROMU
figure 1. 56-years-old male patient. Necrosis was seen on the right buttock. The wound size was approximately 8x3 cm
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Sonntag M, Hodzic-Avdagic N, Bruch-Gerharz D, Neumann NJ.
3.
Embolia cutis medicamentosa after subcutaneous injection of pegylated interferon-α. Hautarzt. 2005;56: 968-9.
Harde V, Schwarz T. Embolia cutis medicamentosa following 4.
subcutaneous injection of glatiramer acetate. J Dtsch Dermatol Ges. 2007;5: 1122-3.
Geukens J, Rabe E, Bieber T. Embolia cutis medicamentosa of the 5.
foot after sclerotherapy. Eur J Dermatol. 1999;9: 132-3.
Cherasse A, Kahn MF, Mistrih R, Maillard H, Strauss J, Tavernier 6.
C. Nicolau’s syndrome after local glucocorticoid injection. Joint Bone Spine. 2003;70: 390-2.
Miranda MC, Rozenfeld S, Olivera SP. A systematic review of the 7.
non-allergic adverse reactions following benzathine penicilline injections. J Vasc Br. 2004;3: 253-60.
De Sousa R, Dang A, Rataboli PV. Nicolau syndrome following 8.
intramuscular benzathine penicillin. J Postgrad Med. 2008;54:
332-4.
Geukens J, Rabe E, Bieber T. Embolia cutis medicamentosa of the 9.
foot after sclerotherapy. Eur J Dermatol. 1999;9: 132-3.
KayNaKLaR
Kim SK, Kim TH, Lee KC. Nicolau syndrome after intramuscular 1.
injection: 3 cases. Arch Plast Surg. 2012;39: 249-52.
Luton K, Garcia C, Poletti E, Koester G. Nicolau syndrome: Three 2.
cases and review. ınt J Dermatol. 2006;45: 1326.
Dr. Elif SARI
Kırıkkale Üniversitesi Tıp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi AD, Yahşihan KıRıKKALE
E-posta: drelifsanli@hotmail.com
