Nicolau syndrome in an athlete following intra-muscular diclofenac injection

Acta Orthop Belg. 2008 Dec;74(6):860-4.


Nicolau Syndrome (also known as Embolia cutis medicamentosa and livedo-like dermatitis) is a rare but severe localized adverse drug reaction to a range of intra-muscular preparations. It manifests as acute pain, cutaneous, subcutaneous and intra-muscular inflammation and necrosis immediately following an injection, with potentially devastating sequelae. We describe the syndrome in a 21-year-old national level race walk athlete following an intramuscular diclofenac injection.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anticoagulants / therapeutic use
  • Diclofenac / administration & dosage
  • Diclofenac / adverse effects*
  • Drug Eruptions*
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Injections, Intramuscular
  • Magnetic Resonance Imaging
  • Male
  • Necrosis
  • Skin Diseases, Vascular / chemically induced*
  • Sports
  • Syndrome
  • Walking


  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Diclofenac