Nicolau syndrome following intramuscular benzathine penicillin injection: a case report

Pan Afr Med J. 2020 Nov 26:37:276. doi: 10.11604/pamj.2020.37.276.21850. eCollection 2020.

Abstract

Nicolau syndrome (NS) is a rare injection site reaction, following intramuscular injection of drugs characterized by severe pain, skin discoloration and varying level of tissue necrosis. The case outcomes vary from severe pain, atrophic ulcers to sepsis and limb amputation. We describe a case of the five-year-old girl with diagnosis of NS after intramuscular benzathine penicillin injection. The case was complicated with above the knee amputation of lower limb. This case report intends to remind clinicians that such rare cases should always be thought of in all patients receiving whatsoever drug via intramuscular injections.

Keywords: Livedo-like dermatitis; Nicolau syndrome (NS); case report; embolia cutis medicamentosa; intramuscular injections.

Publication types

  • Case Reports

MeSH terms

  • Amputation, Surgical / methods
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Child, Preschool
  • Female
  • Humans
  • Injections, Intramuscular
  • Lower Extremity / surgery
  • Nicolau Syndrome / etiology*
  • Penicillin G Benzathine / administration & dosage
  • Penicillin G Benzathine / adverse effects*

Substances

  • Anti-Bacterial Agents
  • Penicillin G Benzathine