[Aseptic tissue necrosis: a severe complication after intramuscular injections].

Aseptic necrosis after intramuscular injection (Nicolau syndrome) occurred in 38 patients. Symptoms were severe immediate pain, swelling and livid discoloration of the skin with development of gangrene of skin and muscle tissue. It was the result of an unintentional intra-arterial injection of toxic substances: to assume an allergic reaction is unwarranted. Since irreversible tissue damage occurs within a short time, treatment results are unsatisfactory. For this reason prevention is essential. Using proper precautions, intra-arterial injections can be largely avoided. Since the greater proportion of these severe complications occurs after the administration of antirheumatic drugs, there should be a fundamental reconsideration of the need for intramuscular application of such drugs, as pharmacologically it is not essential.