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Journals / Düzce Tıp Fakültesi Dergisi / 2026 / Volume: 28 Issue: 2

Intramuscular Ceftriaxone Injection-Induced Nicolau Syndrome: A Case Report

Selen Taner Akbay(HATAY MUSTAFA KEMAL UNIVERSITY)0000-0003-0368-9096
Pages
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Publication Date
2026-08-21
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Conservative wound care, anti-inflammatory therapy and empiric antibiotics led to complete healing with residual hypopigmented atrophic scarring at six months, highlighting the importance of early recognition and proper injection technique.

📌 3 Key Takeaways

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Objective & Hypothesis:Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare ischemic complication of parenteral drug administration.
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Key Findings & Data:We report a 53-year-old man who developed severe pain, swelling, erythema and violaceous necrotic discoloration involving the left gluteal region and extending to the left femoral area after four intramuscular ceftriaxone injections administered by a non-healthcare professional.
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Conclusion & Impact:Conservative wound care, anti-inflammatory therapy and empiric antibiotics led to complete healing with residual hypopigmented atrophic scarring at six months, highlighting the importance of early recognition and proper injection technique.
🔬Design:Case Report
📍Scope:Comprehensive Sample
⚙️Variables:Nicolau syndrome · ceftriaxone · skin necrosis

Abstract

Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare ischemic complication of parenteral drug administration. Ceftriaxone-associated cases are exceptionally uncommon. We report a 53-year-old man who developed severe pain, swelling, erythema and violaceous necrotic discoloration involving the left gluteal region and extending to the left femoral area after four intramuscular ceftriaxone injections administered by a non-healthcare professional. Examination revealed a tender, warm, livedoid-necrotic plaque measuring approximately 20 cm. Histopathology demonstrated epidermal and dermal necrosis, fibrinoid necrosis of dermal vessels and a neutrophil-rich panniculitis-like infiltrate. Doppler ultrasonography did not show arterial or venous occlusion and the clinical course was not compatible with necrotizing fasciitis. Nicolau syndrome was diagnosed. Conservative wound care, anti-inflammatory therapy and empiric antibiotics led to complete healing with residual hypopigmented atrophic scarring at six months, highlighting the importance of early recognition and proper injection technique.

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Cite This Article

Akbay, S. T. (2026). Intramuscular Ceftriaxone Injection-Induced Nicolau Syndrome: A Case Report. Düzce Tıp Fakültesi Dergisi, Volume: 28 Issue: 2. https://doi.org/10.18678/dtfd.1884077

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