title: Nicolau syndrome and localized panniculitis: a report of dual diagnoses with an emphasis on morphea profunda-like changes following injection with glatiramer acetate.
abstract: Glatiramer acetate, given as a 40 mg subcutaneous injection thrice weekly, was recently approved by the FDA based on data suggesting better compliance and a more favorable side effect profile compared to lower dose, daily dosing. The most commonly reported adverse events are transient injection site reactions involving redness and pain at the site; however, more pronounced panniculitis and lipoatrophy have also been reported. Here, we present the case of a 51-year-old female treated with higher dose glatiramer acetate who presented with a cutaneous injection site reaction consistent with Nicolau syndrome. The excised specimen revealed typical glatiramer acetate-associated panniculitis, alongside subcutaneous sclerosis. This case shows the spectrum of cutaneous complications possible with glatiramer acetate injections, the finding of sclerosis being relatively infrequently reported. Given the relatively short duration of trials leading to FDA approval of thrice weekly dosing of glatiramer acetate, clinicians should perform careful clinical and histopathological evaluation and reporting of patients who experience injection site reactions.
authors: School of Medicine, Creighton University, Omaha, NE, USA.
authors: Sarah E
authors: SE
authors: Mott
authors: Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA.
authors: Zachary G
authors: ZG
authors: Peña
authors: Department of Neurology, Oregon Health and Sciences University, Portland, OR, USA.
authors: Rebecca I
authors: RI
authors: Spain
authors: Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA.|Department of Dermatopathology, Oregon Health and Sciences University, Portland, OR, USA.
authors: Kevin P
authors: KP
authors: White
authors: Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA. benjamin.d.ehst@healthpartners.com.
authors: Benjamin D
authors: BD
authors: Ehst
mesh_terms: D005260:Female; D000068717:Glatiramer Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007267:Injections; D008875:Middle Aged; D065148:Nicolau Syndrome / Q000175:diagnosis* / Q000601:surgery; D015434:Panniculitis / Q000139:chemically induced / Q000175:diagnosis* / Q000601:surgery
chemical_list: D000068717:Glatiramer Acetate
keywords: Nicolau syndrome; Relapsing-remitting multiple sclerosis; glatiramer acetate; injection site reaction; subcutaneous sclerosis