Marcus Fokou, Claude Eyenga Victor, Josephine Meli, Teyang Abel
Department of Surgery, Yaounde General Hospital, Yaounde, Cameroon.
Department of Surgery, Yaounde General Hospital, Yaounde, Cameroon.
Ann Vasc Surg. 2019 Jul;58:383.e7-383.e11. doi: 10.1016/j.avsg.2018.11.022. Epub 2019 Feb 13.
Causes of acute limb ischemia are classically mainly emboli and thrombosis. Nicolau syndrome is a very rare complication of intramuscular injection presumed to be related to the inadvertent intravascular injection. It was first reported after intramuscular injection of bismuth salt, but it can occur as a complication of various other drugs. Acute limb ischemia is one of its severe outcomes but is rarely encountered and reported.
Patients admitted with the final diagnosis of Nicolau syndrome in our institution in 3 years (2016 2017 and 2018) are reviewed in terms of etiology, clinical presentation, management, and outcome.
We present here 4 cases of Nicolau syndrome that lead to acute limb ischemia and with the same outcome: limb or fingers loss; there were 2 upper extremities for 2 women secondary to diclofenac and dexamethasone intramuscular administration and 2 lower extremities for 2 men in relation with Benzathine Penicillin intramuscular administration. The medical and surgical management that we attempted did not prevent this severe outcome.
Nicolau syndrome should be considered when looking for rare etiologies of acute limb ischemias.
急性肢体缺血的病因传统上主要是栓子和血栓形成。尼科劳综合征是肌肉注射的一种非常罕见的并发症，推测与意外血管内注射有关。它首次在肌肉注射铋盐后被报道，但也可作为其他各种药物的并发症出现。急性肢体缺血是其严重后果之一，但很少被遇到和报道。
回顾了我院3年（2016年至2017年和2018年）最终诊断为尼科劳综合征的患者的病因、临床表现、治疗及结局。
我们在此呈现4例导致急性肢体缺血且结局相同的尼科劳综合征病例：肢体或手指丧失；2例女性因双氯芬酸和地塞米松肌肉注射导致上肢受累，2例男性因苄星青霉素肌肉注射导致下肢受累。我们尝试的药物和手术治疗均未能阻止这一严重结局。
在寻找急性肢体缺血的罕见病因时应考虑尼科劳综合征。
