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Review
. 2025 Jul 27;19(1):370.
doi: 10.1186/s13256-025-05437-2.

Nicolau syndrome in a pediatric patient after corticosteroid injection: a case report and review of the literature

Bahareh Abtahi-Naeini  1   2 , Sharareh Babaie  3   4 , Sarah Seyedyousefi  2 , Fateme Ahmadinia  5
Affiliations
Review

Nicolau syndrome in a pediatric patient after corticosteroid injection: a case report and review of the literature

Bahareh Abtahi-Naeini et al. J Med Case Rep. .

Abstract

Background: Nicolau syndrome is a rare but serious complication that can occur following various forms of drug administration, particularly intramuscular injections. It is characterized by the onset of painful edema in the affected area shortly after the injection, often accompanied by notable livedoid discoloration of the skin, which can lead to ischemic necrosis of the surrounding skin, soft tissue, and muscular tissue.

Case presentation: Here, we report a 4-year-old Iranian girl who developed significant swelling and discoloration in the buttock area, accompanied by severe pain after receiving an intramuscular injection of triamcinolone acetonide for progressive vitiligo. On the basis of the patient's clinical presentation, medical history, and imaging findings, a definitive diagnosis of NS was established. She was managed effectively with prophylactic antibiotics, analgesics, and antithrombotic therapy.

Conclusion: Healthcare providers must be aware of the potential complications associated with intramuscular injections. Recognizing signs of distress, such as significant pain and discoloration, is crucial for timely intervention, which can significantly improve patient outcomes.

Keywords: Embolia cutis medicamentosa; Nicolau syndrome; Triamcinolone acetonide.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This manuscript has been ethically approved by the Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran, and the approval ID is (IR.ARI.MUI.REC.1404.061). Written informed consent was obtained from the patient’s parents regarding the publication of this data. Consent for publication: Written informed consent was obtained from the patient’s legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: There are no conflicts of interests to be reported.

Figures

Fig. 1
Fig. 1
a Ecchymosis and a cyanotic patch at the injection site, b Livedoid lesion extended to the upper and lower left thigh
See this image and copyright information in PMC

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