# From Needle to Necrosis: A Case Report on Nicolau Syndrome

## TL;DR

This case report describes a rare complication called Nicolau syndrome following an intramuscular injection, highlighting its progression from pain to tissue necrosis.

## Contribution

The novelty lies in presenting a detailed case report and review of Nicolau syndrome triggered by diclofenac injection.

## Key findings

- Nicolau syndrome can occur after intramuscular diclofenac injection.
- The syndrome progresses from pain and discoloration to ischemia and necrosis.
- Understanding inciting factors is crucial for preventing serious complications.

## Abstract

Nicolau syndrome is a rare but dreaded complication that can occur after a routine injection. It causes pain followed by ischemia and necrosis of the area, sometimes leading to serious and potentially life-threatening complications. Various drugs have been attributed to causing this, but only after being administered via an injection. What begins as pain and discoloration of the skin over the injection site quickly takes a sinister turn to become ischemic, ultimately leading to tissue necrosis. As the practice of administering injections is a major part of general medical practice, it becomes crucial to understand the inciting factors and know the potential complications of this otherwise harmless procedure.

Here we report a 51-year-old daily wage worker who had pain followed by dark discoloration and ultimately necrosis and ulceration following an intramuscular injection of diclofenac. This case report elaborates on various causes of Nicolau syndrome, the clinical presentations and treatment options of this disorder.