Nicolau Syndrome due to Penicillin Injection: A Report of 3 Cases without Long-Term Complication

Table 1

Different theories for pathogenesis of the Nicolau syndrome.

Sympathetic nerve stimulation [1, 3]	The sympathetic nerve stimulation by pain (from the periarterial or intra-arterial injection); causes vasospasm and ischemia
Prostaglandin synthesis block [2, 4–6]	Pharmacologic characteristics of NSAIDs which block prostaglandin synthesis; cause vasospasm and ischemia
Embolic occlusion [7–9]	Accidental intra-artery injection causes embolic occlusion of the arteries
Inflammation [5, 10]	Perivascular inflammation caused by cytotoxic reaction to the injected medication
Mechanical injury [2, 5, 11]	Physical obstruction of the blood vessels caused by the lipophilic drugs which penetrated the vessels