Nicolau syndrome following subcutaneous glatiramer acetate injection: A case report and review of the literature

• Published in: Indian journal of pharmacology Vol. 53; no. 6; pp. 489 - 492
• Main Authors: Esme, Pelin, Gahramanov, Irfan, Akıncıoglu, Egemen, Akoglu, Gulsen
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01-11-2021; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow
• Subjects: Adult; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - adverse effects; Care and treatment; Case reports; Case studies; Diagnosis; Diagnosis, Differential; Dosage and administration; Drug Watch; Female; Glatiramer acetate; Glatiramer Acetate - administration & dosage; Glatiramer Acetate - adverse effects; Humans; Iatrogenic diseases; Injections; Injections, Subcutaneous; Multiple Sclerosis - drug therapy; Nicolau Syndrome - diagnosis; Nicolau Syndrome - etiology; Nicolau Syndrome - pathology; Patient outcomes; Pharmacology; Physiological aspects; Side effects; India; Nicolau syndrome; Embolia cutis medicamentosa; glatiramer subacetate; injection
• ISSN: 0253-7613; 1998-3751
• DOI: 10.4103/ijp.ijp_166_21

Nicolau syndrome is a rare serious drug reaction associated with the administering various injectable medications. It is often characterized by an acute and severe pain accompanying erythema that tends to rapidly evolve into the livedoid reticular or hemorrhagic patches and less commonly to ulcers and skin necrosis. Herein, we report a 34-year-old woman who presented with painful, tender discoloration over her abdominal skin following subcutaneous glatiramer acetate injection. Since the patient was diagnosed with multiple sclerosis 18 months ago, she had been on treatment with subcutaneous glatiramer acetate injections thrice weekly. The patient was diagnosed with Nicolau syndrome clinically and histopathologically. After 15-day treatment with topical betamethasone valerate and mucopolysaccharide polysulfate cream twice daily, the lesion completely regressed with only minimal hypopigmented irregular scarring. Nicolau syndrome should be considered in patients with severe pain, tenderness, and redness localized at the injection site following glatiramer subacetate.