Coincidence of Nicolau Syndrome and Rhabdomyolysis: Report of a Forensic Autopsy Case and Review of the Literature.
Nicolau syndrome (NS) is a dermatological adverse reaction of intramuscular injections and is caused by several mechanisms. The etiopathogenesis remains unclear, and several hypotheses have suggested a vascular origin. Rhabdomyolysis (RM) is the destruction of striated muscle, with the subsequent release of muscle cell contents into circulation. NS and RM diagnoses may overlap. Herein, we present the autopsy findings of a 40-year-old female with NS complicated with RM. On clinical follow-up, creatine kinase (CK) was 7146 IU/L, and urea and creatinine levels were elevated on the third day after intramuscular diclofenac injection. Possible ischemic process triggered the RM and subsequent acute renal failure. The opportunity for an early diagnosis was missed because the patient delayed seeking medical aid. The prognosis worsened, and the patient died due to secondary sepsis. Early diagnosis of NS before the occurrence of complications is the most important issue in patient education and can be life-saving.
Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey. mnarslan@yahoo.com.
Murat Nihat
MN
Arslan
Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey.
Deniz Oguzhan
DO
Melez
Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey.
Arzu
A
Akcay
Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey.
Adem
A
Gur
Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey.
Bulent
B
Sam
Haydarpasa Numune Teaching Hospital, Tıbbiye Cad. No:23 Uskudar 34668 Istanbul, Turkey.
Suheyla
S
Guven Apaydın
D058186:Acute Kidney Injury; D000328:Adult; D001344:Autopsy; D003402:Creatine Kinase; D005260:Female; D006801:Humans; D065148:Nicolau Syndrome / Q000150:complications*; D012206:Rhabdomyolysis / Q000150:complications*
D003402:Creatine Kinase
Nicolau syndrome; autopsy; diclofenac; forensic science; intramuscular injection; rhabdomyolysis