Tabor Dominic, Bertram Chandra G, Williams Andrew J K, Mathers Marie E, Biswas Asok
Department of Dermatology, Lauriston Building, Royal Infirmary of Edinburgh, United Kingdom.
Department of General Medicine, St John's Hospital, Livingston, United Kingdom.
Am J Dermatopathol. 2018 Mar;40(3):212-215. doi: 10.1097/DAD.0000000000000972.
Nicolau syndrome is a rare form of iatrogenic cutaneous necrosis which affects injection sites. Although classically associated with intramuscular injections, it may develop after subcutaneous or other routes of parenteral drug administration. Clinically, it manifests as necrotic ulcers that often develop in a background of erythematous and livedoid reticular patches. The histopathologic characteristics of Nicolau syndrome are poorly documented in the dermatopathology literature and features only rarely as one of the obscure causes of cutaneous thrombotic vasculopathy. We report a case of Nicolau syndrome developing secondary to subcutaneous injection of cyclizine to familiarize the clinicians and pathologists to this unusual condition. Given that it is potentially avoidable, pathologists should alert the clinicians to the possibility of Nicolau syndrome when a skin biopsy from an injection site shows signs of extensive thrombotic vasculopathy.
尼科劳综合征是一种罕见的医源性皮肤坏死，影响注射部位。虽然传统上与肌肉注射有关，但它也可能在皮下注射或其他胃肠外给药途径后发生。临床上，它表现为坏死性溃疡，通常在红斑性和类紫癜网状斑的背景下出现。尼科劳综合征的组织病理学特征在皮肤病理学文献中记录较少，仅偶尔作为皮肤血栓性血管病的罕见病因之一出现。我们报告一例因皮下注射赛克利嗪继发的尼科劳综合征病例，以使临床医生和病理学家熟悉这种不寻常的情况。鉴于其有可能避免，当注射部位的皮肤活检显示广泛血栓性血管病迹象时，病理学家应提醒临床医生注意尼科劳综合征的可能性。
