Abstract
A case of Nicolau syndrome (NS) in a 36-year-old adult taking an unusual and devastating hyperacute irreversible paraplegia after an intramuscular injection of benzathine penicillin as a part of routine chemoprophylaxis of her rheumatic heart disease is reported. Although this syndrome is a considerably rare, iatrogenic and underappreciated dermatologic entity, we reiterate in this report, its extracutaneous systemic potential for a catastrophic neurovascular phenomenon and morbidity as well as its possible preventive measures. The apoplectiform onset of T10 flaccid areflexic paraplegia, with the cutaneous hallmark of 'embolia cutis medicamentosa' was corroborated by magnetic resonance imaging evidence of centromedullary complete cord involvement from T10 to conus medullaris. Combination therapy with pulse methylprednisolone, low-molecular-weight heparin, and pentoxifylline infusion proved unsuccessful. The skin biopsy and direct immunofluorescence revealed features were consistent with NS with overlap features of leukocytoclastic vasculitis, hitherto not reported. The literature of this preventable and iatrogenic disorder is reviewed, and plausible etiology is discussed.
| Original language | English |
|---|---|
| Pages (from-to) | 104-108 |
| Number of pages | 5 |
| Journal | Annals of Indian Academy of Neurology |
| Volume | 22 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 01-01-2019 |
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All Science Journal Classification (ASJC) codes
- Clinical Neurology
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Hyperacute paraplegia and neurovascular (immuno vasculotoxic) catastrophe of nicolau syndrome : Primum non nocere. / Shelley, Bhaskara P.; Prasad, Prasanth; Manjunath, Malla M.; Chakraborti, Shrijeet.
In: Annals of Indian Academy of Neurology, Vol. 22, No. 1, 01.01.2019, p. 104-108.Research output: Contribution to journal › Article
TY - JOUR
T1 - Hyperacute paraplegia and neurovascular (immuno vasculotoxic) catastrophe of nicolau syndrome
T2 - Primum non nocere
AU - Shelley, Bhaskara P.
AU - Prasad, Prasanth
AU - Manjunath, Malla M.
AU - Chakraborti, Shrijeet
PY - 2019/1/1
Y1 - 2019/1/1
N2 - A case of Nicolau syndrome (NS) in a 36-year-old adult taking an unusual and devastating hyperacute irreversible paraplegia after an intramuscular injection of benzathine penicillin as a part of routine chemoprophylaxis of her rheumatic heart disease is reported. Although this syndrome is a considerably rare, iatrogenic and underappreciated dermatologic entity, we reiterate in this report, its extracutaneous systemic potential for a catastrophic neurovascular phenomenon and morbidity as well as its possible preventive measures. The apoplectiform onset of T10 flaccid areflexic paraplegia, with the cutaneous hallmark of 'embolia cutis medicamentosa' was corroborated by magnetic resonance imaging evidence of centromedullary complete cord involvement from T10 to conus medullaris. Combination therapy with pulse methylprednisolone, low-molecular-weight heparin, and pentoxifylline infusion proved unsuccessful. The skin biopsy and direct immunofluorescence revealed features were consistent with NS with overlap features of leukocytoclastic vasculitis, hitherto not reported. The literature of this preventable and iatrogenic disorder is reviewed, and plausible etiology is discussed.
AB - A case of Nicolau syndrome (NS) in a 36-year-old adult taking an unusual and devastating hyperacute irreversible paraplegia after an intramuscular injection of benzathine penicillin as a part of routine chemoprophylaxis of her rheumatic heart disease is reported. Although this syndrome is a considerably rare, iatrogenic and underappreciated dermatologic entity, we reiterate in this report, its extracutaneous systemic potential for a catastrophic neurovascular phenomenon and morbidity as well as its possible preventive measures. The apoplectiform onset of T10 flaccid areflexic paraplegia, with the cutaneous hallmark of 'embolia cutis medicamentosa' was corroborated by magnetic resonance imaging evidence of centromedullary complete cord involvement from T10 to conus medullaris. Combination therapy with pulse methylprednisolone, low-molecular-weight heparin, and pentoxifylline infusion proved unsuccessful. The skin biopsy and direct immunofluorescence revealed features were consistent with NS with overlap features of leukocytoclastic vasculitis, hitherto not reported. The literature of this preventable and iatrogenic disorder is reviewed, and plausible etiology is discussed.
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UR - http://www.scopus.com/inward/citedby.url?scp=85059869349&partnerID=8YFLogxK
U2 - 10.4103/aian.AIAN_298_18
DO - 10.4103/aian.AIAN_298_18
M3 - Article
VL - 22
SP - 104
EP - 108
JO - Annals of Indian Academy of Neurology
JF - Annals of Indian Academy of Neurology
SN - 0972-2327
IS - 1
ER -