Nicolau syndrome after lumbar puncture: A case report in a 22-month-old girl

NS: Nicolau syndrome INTRODUCTION Nicolau syndrome (NS) is a rare, aseptic cutaneous necrosis that may involve the subcutaneous and muscle tissue layers. This syndrome is associated with intramuscular, subcutaneous, intravenous, and intra-articular injections of antibiotics, local anesthetics, glucocorticoids, nonsteroidal antiinflammatory drugs, hyaluronic acid, vaccinations, and vitamins. NS presents as an immediate and severe pain at the injection site and a clearly demarcated livedolike discoloration of the skin that progresses to cutaneous necrosis with potential involvement of the underlying tissues. Although the pathophysiology of NS is debated, multiple theories implicate occlusion of cutaneous vessels after iatrogenic insult as an inciting cause. Here, we present the first case, to our knowledge, of NS caused by lumbar puncture.