Nicolau syndrome in an athlete following intra-muscular diclofenac injection

Abstract

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.