A Nicolau Syndrome Confused with Cellulite

Abstract

Nicolau syndrome, also known as embolia cutis medicamentosa or livedoid dermatitis, emerges as a rare complication following intramuscular, subcutaneous, or intraarticular injections. This condition may result in severe pain, erythematous lesions, livedoid and hemorrhagic plaques, as well as necrosis affecting the skin, fat, and muscle layers post-injection. Notable causative agents encompass non-steroidal anti-inflammatory drugs (NSAIDs), etanercept, and antibacterial agents. While there›s no definitive cure for Nicolau syndrome, available treatment options range from wound care, bed rest, and pain management to antibiotics for secondary infections, topical, intralesional, and systemic corticosteroids. Moreover, vasoactive agents like alprostadil and pentoxifylline, anticoagulants, and hyperbaric oxygen therapy can be utilized. In severe cases marked by necrosis, surgical interventions become imperative. This report presents a case where a female patient developed Nicolau syndrome following a diclofenac sodium injection.