• Pietro F Lardelli, Luca M M Jermini, Gregorio P Milani, Gabriella G A M Peeters, Gian P Ramelli, Lorenzo Zgraggen, Isabella Terrani, Mario G Bianchetti, Federica Vanoni, Pietro B Faré, and Lava Sebastiano A G SAG Pediatric Cardiology Unit, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland..
• Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland.
• Int. J. Clin. Pract. 2020 Oct 1; 74 (10): e13567.

AimIntramuscular or, more rarely, local drug injection is occasionally followed by immediate local pain, livedoid skin lesions and, some days later, the development of ischemic lesions. This very uncommon but potentially severe reaction, termed Nicolau syndrome, is traditionally associated with bismuth and β-lactam antimicrobials. The aim of this report was to review the literature associating Nicolau syndrome with the administration of non-steroidal anti-inflammatory drugs.MethodsThe National Library, Excerpta Medica, Web of Science and Cochrane library databases were used.ResultsSixty-two cases (40 females and 22 males aged from 13 to 81, median 57 years) of Nicolau syndrome were published after 1992. Fifty-three cases occurred after diclofenac. The remaining nine cases were associated with ketoprofen (N = 2), ketorolac (N = 2), phenylbutazone (N = 2), etofenamate (N = 1), ibuprofen (N = 1) and piroxicam (N = 1).ConclusionAlthough Nicolau syndrome is extremely uncommon, physicians must be aware of this complication after intramuscular administration of non-steroidal anti-inflammatory drugs and should avoid unnecessary injections.© 2020 John Wiley & Sons Ltd.

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