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LETTERS TO THE EDITOR |
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| Year : 2023 | Volume
: 28
| Issue : 6 | Page : 551-552 |
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Nicolau syndrome: Disastrous consequence of injection sclerotherapy
Nayantara Nair, Amar Jyoti Baruah, Ajay Pannu, Sujit K Chowdhary
Department of Paediatric Urology and Paediatric Surgery, Apollo Institute of Paediatric Sciences, Indraprastha Apollo Hospitals, New Delhi, India
| Date of Submission | 14-Aug-2023 |
| Date of Decision | 24-Sep-2023 |
| Date of Acceptance | 28-Sep-2023 |
| Date of Web Publication | 02-Nov-2023 |
Correspondence Address:
Sujit K Chowdhary
Department of Paediatric Urology and Paediatric Surgery, Apollo Institute of Paediatric Sciences, Indraprastha Apollo Hospitals, New Delhi - 110 076
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaps.jiaps_171_23
How to cite this article:
Nair N, Baruah AJ, Pannu A, Chowdhary SK. Nicolau syndrome: Disastrous consequence of injection sclerotherapy. J Indian Assoc Pediatr Surg 2023;28:551-2 |
How to cite this URL:
Nair N, Baruah AJ, Pannu A, Chowdhary SK. Nicolau syndrome: Disastrous consequence of injection sclerotherapy. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Nov 28];28:551-2. Available from: https://www.jiaps.com/text.asp?2023/28/6/551/389322 |
Sir,
Soft-tissue lumps are frequently encountered surgical lesions in children. The most common lesions are developmental hamartomas which may have a vascular or lymphangiomatous component. We report a case of acute limb ischemia following intralesional sclerotherapy with sodium tetradecyl sulfate for a soft-tissue swelling of the forearm. This is the second reported case of limb ischemia following sodium tetradecyl sulfate (STS) injection in India.[1],[2]
A 5-year-old boy presented to a district hospital with a 2 cm × 2 cm swelling on the dorsal aspect of the right forearm, where he underwent injection sclerotherapy. He reached us on the fourth day after injection sclerotherapy with bluish discoloration of the entire right forearm and loss of movement in the fingers and wrist joint [Figure 1]. An ultrasound Doppler revealed absent flow in radial, ulnar, and brachial arteries. The axillary artery was pulsatile with a normal flow pattern. Vascular surgery, plastic surgery, and orthopedic teams were consulted and advised above-elbow amputation. In view of delay and absent flow in Doppler ultrasound, computed tomography angiography was not considered. The situation was explained to the family and above-elbow amputation was performed. The amputation stump healed well, and he was discharged within a week with physical rehabilitation and prosthesis management over the next few months.
This complication is similar in its etiopathogenesis to Nicolau syndrome, first described in 1925, as iatrogenic necrosis of skin and underlying tissue after intramuscular bismuth injection in syphilis patients. The mechanisms responsible include direct arterial embolization of the vessel, periarterial ischemia due to arterial vasospasm and compression of the vessel by the injected material. Conservative management with anticoagulants and antibiotics has been known to help in patients with early signs of decreased perfusion, in the first 6–12 h.[2]
This case is being reported to highlight the rare but devastating potential complication of injection sclerotherapy with STS in a child.
We recommend close monitoring of the injection site up to 6 h post sclerotherapy, within which any ischemic changes may be reversed, and the limb salvaged.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Deshmukh NS, Abhijit Belgaumkar V, Chavan RB, Bhatt N. Nicolau syndrome following intralesional sclerotherapy: A dreaded complication of a simple office procedure. J Skin Stem Cell 2020;7:107198.  |
| 2. | Nischal K, Basavaraj H, Swaroop M, Agrawal D, Sathyanarayana B, Umashankar N. Nicolau syndrome: An iatrogenic cutaneous necrosis. J Cutan Aesthet Surg 2009;2:92-5. [ PUBMED] [Full text] |
[Figure 1]
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