Fibrinolytic treatment and management in Nicolau syndrome: Clinical case
DOI:
https://doi.org/10.47464/MetroCiencia/vol29/1/2021/51-57Keywords:
Nicolau syndrome, benzylpenicillin, anticoagulant, rt-PAAbstract
Introduction: Nicolau syndrome (NS), known as cutaneous embolism or livedoid dermatitis, is an adverse event due to the administration of intramuscular, intraarterial, subcutaneous and intraarticular injections associated with various drugs1. The entire pathogenesis of this syndrome is unknown, but it has been associated with vascular injury, arterial thrombosis, reflex spasm of the arteries, vascular occlusion due to microemboli, and inflammation. Clinical case: 32-year-old male. After an intramuscular injection of benzathine penicillin, the patient presented severe pain in the injection area accompanied by erythematous lesions at the level of the abdomen, scrotum, and right lower limb. In addition to that, the patient presented pain, paresthesia, and mottled paleness erythema (livedo). Moreover, the patient had a decreased pulse in the right limb, acute ischemia was diagnosed and required fibrinolitic treatment, among other drugs. Conclusion: Nicolau Syndrome, is an iatrogenic condition that is produced by injection of multiple drugs. It can produce different symptoms and signs from neurological injury, necrosis in the irrigation area of affected vessels and acute ischemia. rt-PA management in this case was effective in treating ischemia. It is essential to know about this syndrome and its complications. This would facilitate its management2.
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