The Nicolau Syndrome: A case report and a review of the literature

Nicolau syndrome (NS) is a rare aseptic cutaneous adverse reaction and necrosis caused by intra-muscular, subcutaneous, intravenous, or intra-articular injection of various drugs. We report a case of this syndrome. A 20-year-old male who developed intense pressure pain, the local sensation of heat, and reddish discoloration of the skin after receiving an intramuscular injection of diclofenac for renal colic. The complaints started two days after the injection. The patient was managed at peripheral health care center as a case of post-injection site abscess. However, the patient developed gluteal necrosis and was referred to our tertiary care center for further management. The patient was treated with antibiotics, and aggressive multiple debridements, and healed with secondary intention with an ugly scar. The observed syndrome was due to the injection of the drug into subcutaneous tissue instead of proper muscular planes. Medical and paramedical personnel must be properly educated and sensitized to such a complication that can occur during drug administration. They should follow the standard and appropriate injection techniques and take all necessary precautions to avoid this severe complication, which increases the patient s morbidity. Proper teachings of injection techniques to junior medical and paramedical staff should be exercised at the apex and peripheral centers for the prevention of this syndrome.