NICOLAU SYNDROME: CUTANEOUS NECROSIS FOLLOWING DICLOFENAC INTRAMUSCULAR INJECTION

Nicolau syndrome, although it is quite rare, often occurs following Intramuscular injections of different medications, especially diclofenac and pencillin's. Accordingly, its symptoms usually begin with severe pain during injection, leading to ulceration and necrosis of the local tissue over time. Immediate diagnosis and treatment in the case of the syndrome are of great Importance. Diclofenac is class of NSAID's act as anti-inflammatory drug through inhibiting the Cycloxygenase-I and Cycloxygenase-II (COX-I AND COX-II) enzymes.

In our case report we report the case of a 23-year-old female who developed the Nicolau Syndrome after an intramuscular injection in her left gluteal region of single dose diclofenac sodium to treat a headache, body ache, and chills. A physical examination revealed skin necrosis with the size of approximately 5×5cm. The patient was managed by administering intravenous antibiotics and analgesics, followed by surgical debridement, leading to satisfactory wound healing.

This case highlights the importance of recognizing early warning signs of NS and adopting safe injection practices to prevent this serious adverse effect. Clinicians should be aware of the potential risks associated with intramuscular injections and take steps to minimize them.