Nicolau Syndrome following Benzathine Benzylpenicillin Injection in a Patient with Syphilis and Type 2 Diabetes: A Case Report.

INTRODUCTION

Nicolau syndrome (NS) is a rare complication following intramuscular (IM), intra-articular, or subcutaneous injections, marked by severe localized pain, skin discoloration, and tissue necrosis. Treatments focus on halting causative agents, pain control, and preventing secondary infections. Here we describe a case of NS due to the use of penicillin G benzathine for syphilis.

CASE PRESENTATION: A 39-year-old male presented with a painful rash on his left buttock 3 min after IM injection of penicillin G benzathine for the treatment of syphilis. The patient, with a history of type 2 diabetes, experienced significant complications including rhabdomyolysis and liver dysfunction. After the treatment of corticosteroids, anticoagulation, fluid resuscitation, and alkalinizing the urine, the patient recovered well.

CONCLUSION

NS may result from accidental arterial injection (causing vascular occlusion) or hypersensitivity reactions to medications. We reported the clinical course of a case of NS and highlight the need for proper injection technique, early intervention, and multidisciplinary care to manage NS and its complications.