Summary

Introduction: Nicolau syndrome (NS) or embolia cutis medicamentosa refers to cutaneous necrosis following arterial injection of certain drugs under an oily suspension form. Less common, intravenous or intramuscular injection of water sollutions drugs can also produce NS. ªtefan Gheorghe Nicolau described the first case in 1925, after injection of bismuth oily salls in a patient with syphilis and named this drug reaction Livedoid and Gangrenous Dermatitis of Nicolau.

Case presentation: A 43-year-old-male with a known history of chronic alcohol comsumption and secondary nutrional deficiencies presented for a reticulated purpuric patch located on the left buttock. The lesion developed two days after vitamine B injection. Based on the anamnesis and clinical data, the diagnosis of Nicolau Syndrome caused by vitamin B injection was established. The therapeutic attitude consist of systemic corticotherapy and pentoxifiline without improvement. Finally, surgical debridement was necessary and the wound healed with atrophic scarring.

Conclusions: Nicolau syndrome is a rare, potentially severe skin complication following improper administration of injectable drugs that produce necrosis of the soft tissue. Surgical debridement is necessary in the majority of the cases.