Embolia cutis medicamentosa following subcutaneous injection of glatiramer acetate

Embolia cutis medicamentosa (ECM) is a rare side effect observed primarily after intramuscular injections. It is associated with localized, sometimes extensive necrosis of the skin. Reflex vasospasm induced by the injection trauma may be etiologically involved. It is a potentially serious reaction which is little influenced by which drug is injected. A patient developed typical ECM after subcutaneous selfinjection of glatiramer acetate for multiple sclerosis. This case is remarkable since 1) ECM developed after subcutaneous and not after intramuscular injection, 2) the injection was given by the patient himself, and 3) glatiramer acetate can induce skin necrosis as a side effect. ECM can be easily differentiated from the latter by its typical clinical features.