• P I Pillans and N O'Connor.
• Department of Pharmacology, University of Cape Town Medical School, South Africa.
• Ann Pharmacother. 1995 Mar 1; 29 (3): 264-6.

ObjectiveTo report 6 cases of severe local reactions associated with intramuscular injection of diclofenac.Case SummariesThree patients developed extensive tissue necrosis at the injection site after intramuscular diclofenac. Necrotizing fasciitis in an additional 3 patients was associated with complications such as adult respiratory distress syndrome, renal failure, shock, and disseminated intravascular coagulation. Organisms were cultured from the necrotic site in 3 cases. Two patients died.DiscussionTissue necrosis is a rare but serious complication of intramuscular administration of medicines, including nonsteroidal antiinflammatory drugs (NSAIDs). Pain often occurs at the time of the injection, but tissue necrosis typically becomes apparent a few days later. Necrotizing fasciitis is characterized by rapidly spreading infection with necrosis of fascia and subcutaneous fat.ConclusionsIntramuscular administration of diclofenac may be associated with severe tissue necrosis or necrotizing fasciitis. Although rare, these serious complications should be considered when intramuscular injection of NSAIDs is contemplated.

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