Intramuscular Ceftriaxone Injection-Induced Nicolau Syndrome: A Case Report
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.
Keywords
References
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Details
Primary Language
English
Subjects
Dermatology
Journal Section
Case Report
Authors
Publication Date
August 21, 2026
Submission Date
February 9, 2026
Acceptance Date
July 25, 2026
Published in Issue
Year 2026 Volume: 28 Number: 2
