# Nicolau Syndrome Following Glatiramer Injection in a Middle-Aged Woman

## TL;DR

A middle-aged woman with multiple sclerosis developed Nicolau syndrome after a glatiramer injection, requiring wound care and debridement for recovery.

## Contribution

This case report highlights Nicolau syndrome as a rare adverse effect of glatiramer injection in multiple sclerosis patients.

## Key findings

- Nicolau syndrome occurred after a subcutaneous glatiramer injection in a 55-year-old woman.
- The condition was managed with wound debridement, topical mupirocin, and regular dressing changes.
- The patient showed excellent resolution with continued follow-up care.

## Abstract

Nicolau syndrome is a rare adverse reaction that can occur in the setting of intramuscular, intravenous, and subcutaneous injections. Proper diagnosis and management are critical to avoid complications including abscesses, muscular atrophy, and necrotizing fasciitis. Here, we report a 55-year-old female with multiple sclerosis who presented to our clinic following a subcutaneous injection of 40mg of glatiramer. She immediately noted a sharp pain and erythema, which developed into a purple discoloration, became purulent, and eventually necrosed. The patient’s wound was debrided, and she was advised to clean the wound with soap and water, apply topical mupirocin, and change dressings twice daily. She continued to receive appropriate follow-up care with weekly to bi-weekly debridement with excellent resolution.