title: Recurrent Nicolau syndrome associated with subcutaneous glatiramer acetate injection--a case report.
abstract: BACKGROUND
  Glatiramer acetate is worldwide used as first line treatment in relapsing remitting multiple sclerosis. Local skin reactions associated with glatiramer acetate are common, however, only isolated cases of severe local injection site reactions known as Nicolau Syndrome have been reported so far.
  
  
  METHODS
  We describe the case of a recurrent Nicolau Syndrome occurred during longstanding glatiramer acetate treatment in a woman with multiple sclerosis. The haemorrhagic patch necrotized and was treated locally as a deep second degree burn with excision of dead skin tissue and was healed. Treatment with glatiramer acetate was definitely suspended.
  
  
  CONCLUSIONS
  GA injections can be complicated by isolated or recurrent Nicolau Syndrome, a potentially life-threatening condition of which neurologists should be aware.
authors.affiliation: Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale, Lugano, 6903, Switzerland. chiara.zecca@eoc.ch.
authors.forename: Chiara
authors.initials: C
authors.lastname: Zecca
authors.affiliation: Department of Dermatology, Ospedale Regionale Bellinzona e Valli, Bellinzona, 6500, Switzerland. info@carlomainetti.ch.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mainetti
authors.affiliation: Department of Dermatology, Inselspital, University Hospital, University of Bern, Bern, 3010, Switzerland. Roland.Blum@insel.ch.
authors.forename: Roland
authors.initials: R
authors.lastname: Blum
authors.affiliation: Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale, Lugano, 6903, Switzerland. claudio.gobbi@eoc.ch.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gobbi
mesh_terms: D005260:Female; D000068717:Glatiramer Acetate / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007279:Injections, Subcutaneous; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D065148:Nicolau Syndrome / Q000209:etiology*; D012008:Recurrence
chemical_list: D007166:Immunosuppressive Agents; D000068717:Glatiramer Acetate