Gal Shaili, Dart Paul E, Movassaghi Kiya
Oregon Health and Science University, Portland, OR.
Aesthet Surg J Open Forum. 2020 Jun 24;2(3):ojaa027. doi: 10.1093/asjof/ojaa027. eCollection 2020 Sep.
Nicolau syndrome (NS) is a rare iatrogenic syndrome usually following intramuscular (IM) injection of various described medications. The typical presentation involves immediate injection site pain and development of a livedoid reticular patch, which can progress to muscle necrosis requiring surgical debridement. The pathophysiology is unclear, although vasoconstrictive etiologies have been implicated. Treatment ranges from supportive care to surgical debridement. The authors present a case report of this syndrome as well as a review of the literature and introduction to a new treatment modality. NS in a 52-year-old woman following IM injection of Demerol and Phenergan to address pain and nausea before discharge is reported. This occurred in the post-anesthesia care unit after aesthetic breast surgery in an ambulatory surgery center. Our patient had immediate injection site pain and a hemorrhagic patch was evident on her physical examination the following day. With local care and hyperbaric oxygen therapy, her lesion improved in appearance. However, she continued to have debilitating pain and was referred to a specialist for osteopathic manipulative therapy (OMT), which had the greatest impact on her pain level. After multi-modal therapy was initiated, the syndrome ultimately resolved without the need for surgical debridement. However, she continues to experience pain and ambulates with a limp due to muscle atrophy. NS is a rare diagnosis that can have devastating complications that can be averted by early recognition and initiation of treatment modalities. In this case, the authors introduced OMT as a new treatment modality, with the potential to improve the progression of this syndrome.
尼科劳综合征（NS）是一种罕见的医源性综合征，通常发生在肌肉注射多种所述药物之后。典型表现包括注射部位立即疼痛，并出现类紫癜样网状斑，可进展为肌肉坏死，需要手术清创。尽管血管收缩病因被认为与之有关，但其病理生理学尚不清楚。治疗方法从支持治疗到手术清创不等。作者介绍了该综合征的一例病例报告以及文献综述，并引入了一种新的治疗方式。报告了一名52岁女性在出院前肌肉注射度冷丁和非那根以缓解疼痛和恶心后发生NS的情况。这发生在一家门诊手术中心的美容乳房手术后的麻醉后护理单元。我们的患者注射部位立即疼痛，第二天体格检查时可见出血斑。通过局部护理和高压氧治疗，她的皮损外观有所改善。然而，她仍有使人衰弱的疼痛，并被转介给一位专家进行整骨手法治疗（OMT），这对她的疼痛程度产生了最大影响。在开始多模式治疗后，该综合征最终得以解决，无需手术清创。然而，由于肌肉萎缩，她仍感到疼痛，走路一瘸一拐。NS是一种罕见的诊断，可能会有毁灭性的并发症，通过早期识别和启动治疗方式可以避免。在这个病例中，作者引入OMT作为一种新的治疗方式，有可能改善该综合征的病程。
