Nicolau syndrome after lidocaine injection and cold application: a rare complication of breast core needle biopsy.

摘要

Nicolau syndrome (embolia cutis medicamentosa or lived-oid dermatitis) was first described by Freuhdental and Nicolau in 1914 and 1925. It is defined as local aseptic cutaneous, and sometimes muscular, necrosis observed at the injection site of an intramuscular preparation. Patients typically present with intense pain at the injection site with pallor owing to local reflex vasospasm, followed by an erythematous maculae evolving after 24 h into a lived-oid violaceous patch with dendritic extensions. This patch becomes hemorrhagic and then necrotic. The necrosis often involves the muscle and is demarcated over 1-2 weeks. The eschar eventually sloughs, and the underlying ulcer heals over months, leaving an atrophic scar devoid of anexal structures. The evolution is unpredictable, and the syndrome has been associated with morbid complications such as widespread cutaneous necrosis, transitory or permanent ischemia of the ipsilat-eral limb, various neurologic complications, isolated muscular necrosis without skin lesions and superimposed infection.