Nicolau syndrome: A series of three cases following drug's intramuscular injection in children

Nicolau's syndrome, also known as embolisa cutis medicamentosa, is a rare iatrogenic complication of intramuscular injections causing ischemia of the skin and soft tissue. Its etiopathogeny remains poorly understood and is based on various theories incriminating an acute vascular spasm. Its clinical presentation is variable, ranging from severe pain with skin ulceration at the intramuscular injection site on the limb to ischemic necrosis of the entire limb. The authors report three cases of advanced ischemic necrosis of the lower limb after intramuscular injection in a 14-day-old male neonate, an 11-month-old female infant and a 6-year-old male child. The obliteration of the feeder vessels was confirmed by Doppler ultrasound and CT angiography in two cases. Unfortunately, the management consisted of lower limb segment amputation. The post-operative courses were uneventful. Rapidly progressive ischemia of the lower limb following an intramuscular injection should immediately suggest Nicolau's syndrome and lead to the immediate initiation of specific treatment.