College of Pharmacy and Health Science, Butler University, Indianapolis, IN, USA.
Franciscan Physician Network Oncology and Hematology Specialists of Indianapolis, Franciscan Health Indianapolis, IN, USA.
J Pharm Pract. 2022 Dec;35(6):1034-1038. doi: 10.1177/08971900211012263. Epub 2021 Apr 29.
A case of embolia cutis medicamentosa (Nicolau syndrome) in a patient receiving monthly intramuscular fulvestrant injections is presented.
An 85-year-old woman receiving monthly fulvestrant injections in the outpatient setting developed a necrotic lesion at the fulvestrant injection site on her right buttock. Her medical history is notable for metastatic breast cancer with bone metastases. Prior to developing the necrotic lesion, the patient was receiving monthly fulvestrant injections for 6 years. Other potential causes such as infection and pressure necrosis were ruled out clinically. After 185 days of wound care involving multiple surgical debridements, topical therapy, and frequent follow-up appointments, the patient's wound resolved with 100% epithelialization. Nicolau syndrome has been reported with other non-vesicant, injectable medications such as antibiotics and corticosteroids; however, it has not been previously reported with fulvestrant.
Nicolau syndrome developed in the right buttock of a patient with metastatic breast cancer following an intramuscular fulvestrant injection. Healthcare practitioners need to be cognizant of this adverse effect with intramuscular injections in order to recognize and refer patients for wound care evaluation early in the evolution of this syndrome. Proper injection technique is recommended to reduce the risk of this idiopathic adverse effect.
报告 1 例接受每月肌内注射氟维司群的患者发生药物性皮肤栓塞（尼科劳综合征）。
一名 85 岁女性因转移性乳腺癌伴骨转移，在门诊接受每月氟维司群肌内注射。在右臀部氟维司群注射部位出现坏死性病变之前，患者已接受该治疗 6 年。临床排除了感染和压迫性坏死等其他潜在病因。经过 185 天的伤口护理，包括多次清创术、局部治疗和频繁的随访，患者的伤口完全上皮化，愈合率达 100%。尼科劳综合征已报道与其他非刺激性、可注射药物（如抗生素和皮质类固醇）有关，但尚未有氟维司群引起该综合征的报道。
在接受氟维司群肌内注射后，转移性乳腺癌患者右臀部发生尼科劳综合征。医疗保健提供者需要了解这种肌内注射的不良反应，以便在这种综合征出现时及早识别并为患者提供伤口护理评估。建议采用适当的注射技术，以降低这种特发性不良反应的风险。
