Nicolau Syndrome Following Intramuscular Diclofenac Sodium Injection: A Rare Case Report

Nicolau syndrome is a rare local complication of intramuscular injection of Diclofenac sodium. Cases have been reported following injection of some other drugs like penicillin, antihistaminic, antiepileptic, corticosteroid and lidocaine. Avascular necrosis is attributed as etiopathogenesis and diagnosis of the condition is clinical. It is managed by debridement of necrotic tissue, wound dressing, analgesic, antibiotics and skin grafting whenever required. The ulcer may heal in months leaving a depressed scar. Incidences of disability and death have been reported in extreme cases. A 74 year old lady was treated with intramuscular injection of Diclofenac Sodium for postoperative pain on 8thpostoperative day following total abdominal hysterectomy with bilateral Salpingectomy. She developed intense pain followed by a necrotic lesion over the injection site for which she was treated with debridement and wound dressing. Secondary suture was applied later. Outcome was good on removal of sutures. Though Nicolau syndrome is not completely preventable, steps can be taken to avoid this devastating pathology. We report this rare condition of Nicolau syndrome to bring about awareness of the entity and adoption of proper procedure of injection as the primary steps in its prevention.