Nicolau syndrome, a rare pathology after benzatinic penicillin administration

Abstract

Introduction: Nicolau syndrome, also known as drug embolia cutis or livedoid dermatitis, is a rare pathology that occurs as a complication of an intramuscular, intraarterial or subcutaneous injection, with varying degrees of tissue injury, including necrosis of the skin and soft tissues. Physiopatogene is unknown, but is thought to be related to an initial vascular injury, with local inflammation, reflex arterial vasoconstriction, local arterial thrombosis and vascular occlusion by microembols. Treatment involves thrombolysis and deflation. Less commonly, complications could be extensive necrosis, amputations, and even death.

 Objective: Describe a clinical case focused on Nicolau syndrome, an uncommon pathology following administration of benzynine penicillin.

 Material and methods: Descriptive, retrospective study, presentation of a clinical case.

 Results: The clinical case of a 32-year-old male patient, with no pathological history, is described for severe pain in the right buttock with total limitation to movement, 24 hours of evolution, with the apparent cause of the self-administation of benzynic penicillin. Physical examination, in the right gluteal region a painful violet plaque is observed to palpation, lower right limb with no tone and seizure. Femoral pulse and decreased poplateus, absent pedium, with right acrocianosis. Laboratory, leukocytes 24,470, dimer D 4292, LDH 837, CPK 1282, rapid negative COVID-19 test. Right lower limb doppler echo with decreased blood flow. Fibrinolytic and immediate support treatment with favorable evolution. After the patient's assessment, a definitive diagnosis and immediate medical treatment was determined, managing to avoid further complications. As an initial diagnostic impression, nonspecific sciatic nerve injury was suspected. As a rare pathology, the final diagnosis was carried out after a detailed analysis of the case and complementary examinations.  The examples below have been aut.

 Conclusions: Nicolau syndrome is a rare pathology, laboratory and imaging tests are needed for final diagnosis. It may occur after improper administration of a daily medicine, such as benzynine penicillin