Nicolau Syndrome in an Elderly Woman: A Case Report

Abstract

Nicolau syndrome is an uncommon complication following the intramuscular administration of medication, primarily non-steroidal anti-inflammatory drugs (NSAIDs) and penicillin. Although rare, this syndrome is distinguished by its clinical presentation, characterized by severe immediate post-injection pain and a clinical course which may progress to necrosis and superinfection of the affected area. The case of an elderly female patient with a history of prediabetes and obesity is presented, she developed a necrotic lesion after an intramuscular injection of a combination of diclofenac, lidocaine, and vitamin B complex. Despite antibiotic treatment and daily wound care, the lesion progressed, leading to necrosis and the formation of a gluteal collection. Surgical cleansing, debridement, and wound closure were performed, yielding favorable postoperative results. This case underscores the importance of clinical diagnosis based on medical history and physical examination for Nicolau syndrome, emphasizing that, although infrequent, its presentation and clinical progression can have serious consequences if not suspected and managed appropriately. Additionally, it highlights the importance of safe injection practices as a preventive measure for this syndrome and the warnings of the diclofenac injection in obese women.