[Nicolau livedoid dermatitis with severe neurological involvement in a child]

Abstract

Background: Nicolau syndrome is a rare condition consisting in tissue ischemia and necrosis following intramuscular, intra-articular or subcutaneous injection.

Patients and methods: Immediately after gluteal intramuscular injection of benzathine-penicillin, a 10-year-old male child presented an extensive painful violaceous lesion on the left buttock associated with urinary incontinence and left lower-limb paresis. Additional underlying muscular damage was supported by high serum levels of creatine kinase and lactate dehydrogenase. Treatment was based on fluid expansion, intravenous steroids and anticoagulants, resulting in improvement of cutaneous and muscular lesions. Improvement in terms of neurological dysfunction was obtained after regular neuromuscular rehabilitation.

Discussion: This case underlines the need to prevent Nicolau syndrome by means of compliance with the technical recommendations for intramuscular injections.

Keywords: Benzathine–penicillin; Benzathine–pénicilline; Dermite livédoïde; Injection intramusculaire; Intramuscular injection; Livedoid dermatitis; Nicolau syndrome; Syndrome de Nicolau.