Nicolau Syndrome: A Case Report of a Rare Debilitating Complication Following Intramuscular Injection of Penicillin

Abstract

Objective: Nicolau Syndrome is a rare, debilitating and sometimes fatal complication resulting from the administration of parenteral medication. It is associated with administration of a variety of medications. It causes a local aseptic ischaemic necrosis of the muscles, subcutaneous tissues and skin. It may be associated with neurological deficits and organ failure. The administration of parenteral medication is common in our health institutions, but this complication seems to be unknown. We would like to increase awareness
about its existence and the preventive measures to take in order to minimize its occurrence as it can be associated with significant morbidity and even mortality.
Case report and interventions: A young man presented with sudden onset of severe pain in the right buttock and the whole right lower limb with associated paralysis after an intramuscular injection of penicillin. He developed a darkened patch of skin at the site of the injection on the right buttock and also on the right leg anteriorly. This progressed to necrosis of the skin, subcutaneous tissue and muscles and osteomyelitis of the right tibia. He also presented with acute renal failure. After serial debridement, wound dressing and
antibiotic treatment the wound healed with extensive scarring, the osteomyelitis resolved and the neurological deficit improved leaving a foot drop. His renal function normalized after several sessions of haemodialysis.
Conclusion: Administration of parenteral medication can be complicated by debilitating conditions such as Nicolau Syndrome. No specific treatment exists, so it is best prevented by taking the necessary precautions during administration of parenteral medication when indicated.