Case Report
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, 4ā6] | Pharmacologic characteristics of NSAIDs which block prostaglandin synthesis cause vasospasm and ischemia | Embolic occlusion [7ā9] | 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 |
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