Blind A, Lenormand C, Schissler C, Cribier B, Lipsker D
Clinique de dermatologie, hôpital Civil de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
Clinique de dermatologie, hôpital Civil de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
Ann Dermatol Venereol. 2018 Nov;145(11):671-675. doi: 10.1016/j.annder.2018.04.012. Epub 2018 Sep 11.
Subcutaneous glatiramer acetate, commercialized under the name of Copaxone, is licensed for the treatment of relapsing multiple sclerosis. Its major adverse effects are skin reactions at the injection site. Nicolau syndrome is a rare but serious iatrogenic accident. Herein we report a case seen in a setting of change of dosage and administration rate of Copaxone.
A 64-year-old woman, treated since 2010 with daily sub-cutaneous injections of Copaxone 20mg/L, reported the appearance of a painful, indurated and erythematous plaque in the suprapubic area following changeover to 40mg/mL injections three times weekly. The suprapubic injections were continued and ugly greyish spots with stellate purpuric borders appeared. Fournier gangrene was ruled out by means of a soft tissue scan.
We report this latest case of Nicolau syndrome to alert readers to the non-exceptional nature of this complication associated with use of glatiramer acetate, particularly at a dosage of 40mg/L injections three times weekly. In our case, onset of Nicolau syndrome appears to have been favored by continued injection in areas already showing inflammation. Re-injection of the drug in these areas should thus be proscribed.
以Copaxone为商品名上市的皮下注射醋酸格拉替雷被批准用于治疗复发型多发性硬化症。其主要不良反应是注射部位的皮肤反应。尼科劳综合征是一种罕见但严重的医源性事故。在此我们报告一例在Copaxone剂量和给药频率改变情况下出现的病例。
一名64岁女性，自2010年起每日皮下注射20mg/L的Copaxone，在改为每周三次注射40mg/mL后，耻骨上区域出现疼痛、硬结和红斑性斑块。继续进行耻骨上注射后，出现了带有星状紫癜边界的难看灰色斑点。通过软组织扫描排除了福尼尔坏疽。
我们报告这例最新的尼科劳综合征病例，以提醒读者这种与使用醋酸格拉替雷相关的并发症并非罕见，尤其是在每周三次注射40mg/L的剂量时。在我们的病例中，尼科劳综合征的发生似乎因在已出现炎症的部位继续注射而加剧。因此，应禁止在这些部位再次注射该药物。
