EC Paediatrics

Introduction: Nicolau’s syndrome, embolism cutis or livedoid dermatitis, is an uncommon pathology that occurs as a complication of an intramuscular, intra-arterial, or subcutaneous injection.

Case Presentation: A1-year-10-month infant who was admitted to the Hospital para el Niño Poblano, after the intramuscular application of metamizole and ampicillin, with the appearance of purplish color changes that doesn’t disappear with acupressure in the left buttock, with progression to the rest of the left pelvic extremity. Initially, it was managed with conservative treatment, without improvement, advanced airway management was performed, as well as various surgical procedures for complications with adequate evolution, a biopsy was taken with a report of necrosis of skin and subcutaneous soft tissues associated with vascular and venous thrombosis.

Discussion: Nicolau's syndrome is characterized by severe pain at the application site, followed by cutaneous and/or neurological changes usually within 24 hours, with purplish livedoid macula/plaque being the most common manifestation, which may progress to skin necrosis; the diagnosis is clinically associated with the history of intramuscular drug application, mainly, and the prognosis depends on the treatment and timely diagnosis.

Conclusion: As it is a condition with a rare occurrence, the diagnosis can be delayed and incorrect. For this reason, it is concluded that Nicolau´s Syndrome, being an infrequent pathology in which clinical presentation and the duration of the condition influence it’s a prognosis, underscores the critical importance of timely diagnosis and multidisciplinary management to reduce morbidity and mortality.

 Keywords: Case Report; Nicolau’s Syndrome; Intramuscular Injection

1. Tovar Noroña Carla Estefanía., et al. “Síndrome de Nicolau, Una Patología Infrecuente Tras La Adminitración de Penicilina benzatinica”. Mediciencias UTA1 (2021): 31.
2. Cárdenas Edgar., et al. “Tratamiento y Manejo fibrinolítico en síndrome de and nbsp; Nicolau: Caso Clínico”. Metro Ciencia1 (2021): 51-57.
3. Gómez Alba Virgen., et al. “Síndrome de Nicolau. Manejo Conservador. Caso Clínico”. Ciencia y Salud2 (2019): 57-63.
4. Raju Bharath., et al. “Nicolau´s syndrome, masquerader of postinjection sciatic nerve injury: Case report and review of literature”. World Neurosurgery 143 (2020): 51-55.
5. Shelley Bhaskara P., et al. “Hyperacute paraplegia and neurovascular (immuno vasculotoxic) catastrophe of Nicolau´s syndrome: Primum Non Nocere”. Annals of Indian Academy of Neurology1 (2019): 104.
6. Torchetti Jimena Lorena., et al. “Síndrome de Nicolau”. Dermatología Argentina1 (2023): 46-48.
7. Rodríguez Arias Edwin A., et al. “Síndrome de Nicolau”. Medicina1 (2023): 145-148.
8. Discua-Guifarro D., et al. “Síndrome de Nicolau en paciente pediátrico posterior a la inyección intramuscular de penicilina benzatínica. Reporte de caso”. iMedPub Journals4 (2015): 12.
9. Tijen Alkan Bozkaya., et al. "Anticoagulant and vasodilator therapy for Nicolau´s syndrome following intramuscular benzathine penicillin injection in a 4 year old boy". Archivos Argentinos de Pediatría3 (2016).
10. Shelley Bhaskara P., et al. “Hyperacute Paraplegia and Neurovascular (Immuno Vasculotoxic) Catastrophe of Nicolau´s syndrome: Primum Non Nocere”. Annals of Indian Academy of Neurology1 (2019): 104-108.