64595 Embolia Cutis Medicamentosa: An Underrecognized Diagnosis Associated with Injectable Medication Use

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

J Am Acad Dermatol

Abstract

A 42-year-old female with a history of multiple sclerosis on glatiramer acetate injections presented to dermatology clinic with a two-week history of painful skin changes on left hip that started one day after her last glatiramer acetate injection. Physical examination revealed two well-demarcated, purpuric plaques with erythematous borders and areas of vesiculation on the left hip. The patient was diagnosed with embolia cutis medicamentosa and started on triamcinolone 0.1% ointment daily for two weeks, vaseline, and warm compress. At 1 month follow up there was symptomatic improvement and healthy granulation tissue, and at 2 month follow up patient had a small residual pink atrophic plaque with minimal desquamation. Embolia cutis medicamentosa, also known as Nicolau syndrome, which is a rare but severe complication that can follow intramuscular, intravenous, or subcutaneous injections of various medications. Pathophysiology involves accidental intra-arterial injection or intravascular drug deposition, leading to vascular occlusion, ischemia, and tissue necrosis. Other injectables linked to Nicolau syndrome include NSAIDs (especially diclofenac), IM benzathine penicillin, local anesthetics such as lidocaine, and, less commonly, injectable vitamins including Vitamin K and cyanocobalamin. Prompt recognition and intervention are critical to prevent extensive tissue damage. Treatment primarily involves supportive care with wound management, topical corticosteroids, and pain control. Early pharmacological interventions, such as vasodilators (nitroglycerin or nifedipine) to enhance blood flow, and anticoagulants to prevent vascular occlusion, may also be considered. In severe cases, surgical debridement may be required for extensive necrosis.

Volume

93

First Page

AB42

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