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Kang Q, Huang Z, Qian W. Nicolau Syndrome with Severe Facial Ischemic Necrosis after Endodontic Treatment: A Case Report. J Endod 2024; 50:680-686. [PMID: 38387794 DOI: 10.1016/j.joen.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
Nicolau syndrome (NS) is a rare complication resulting from intramuscular injections. It is characterized by severe pain at the injection site and the development of purplish discoloration. Only a limited number of case reports have been published documenting the adverse effects associated with the injection of calcium hydroxide (CH) beyond the apex during endodontic treatment. Here, we present the case of a 16-year-old female with NS after the injection of CH during the root canal treatment. The radiography examination revealed distal occlusion of the right maxillary and facial arteries. This caused a substantial area of skin necrosis to develop on the patient's face, resulting in permanent scarring. NS is associated with the displacement of CH beyond the apex. To minimize the risk of NS, dentists should exercise caution by avoiding forced injection of CH during treatment, particularly when the root canal is actively bleeding.
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Affiliation(s)
- Qiongyi Kang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China
| | - Zhengwei Huang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China
| | - Wentao Qian
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China.
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2
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Udawatta M, Mateen FJ. Nicolau syndrome following glatiramer acetate for multiple sclerosis: Case and review of reports. Ann Clin Transl Neurol 2024; 11:1080-1085. [PMID: 38483009 PMCID: PMC11021678 DOI: 10.1002/acn3.52044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 04/18/2024] Open
Abstract
Nicolau syndrome is a rare, iatrogenic skin reaction after parental drug administration, characterized by severe pain at an injection site, followed by hemorrhage, ulceration, and often necrosis. We present a case of a patient on glatiramer acetate for many years (initially Copaxone then Glatopa) who developed Nicolau syndrome, the second reported case after generic glatiramer acetate. All reported cases of Nicolau syndrome after glatiramer acetate are reviewed. The case highlights the importance of prompt recognition of this skin reaction by neurologists and raises awareness of the risks of skin reactions even in low-risk injectable DMTs.
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Affiliation(s)
- Methma Udawatta
- Department of NeurologyBrigham and Women's HospitalBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Farrah J. Mateen
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
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3
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Consolascio D, Bronz G, Lardelli PF, Milani GP, Lava SAG, Terziroli Beretta Piccoli B, Bianchetti MG, Bergmann MM, Rizzi M. Hoigné's syndrome, an uncommon mimicker of anaphylaxis: Systematic literature review. J Autoimmun 2024; 143:103164. [PMID: 38194789 DOI: 10.1016/j.jaut.2023.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
The term Hoigné's syndrome denotes a mimicker of anaphylaxis, which occurs immediately after the parenteral administration of a drug and is likely caused by non-thrombotic pulmonary and systemic drug micro-embolization. It has so far been documented uniquely in case reports and small case series. Because this condition has never been systematically evaluated, we performed a structured literature review (pre-registered as CRD42023392962). The search was carried out in Excerpta Medica, National Library of Medicine, and Google Scholar. Cases with features consistent with anaphylaxis, urticaria, angioedema, asthma, syncope, anxiety, or panic attack triggered by needle phobia, and local anesthetic systemic toxicity were excluded. For the final analysis, we retained reports published between 1951 and 2021, which presented 247 patients with Hoigné's syndrome: 37 children and 211 adults with a male: female ratio of 2.1 : 1.0. The patients presented within 1 min after parenteral administration of a drug (intramuscular penicillin in 90 % of the cases) with chest discomfort, shortness of breath, fear of death, psychomotor agitation, and auditory or visual hallucinations and impairment. Recovery occurred within 30 min. The diagnosis of Hoigné's syndrome was also established in five patients 66-91 years of age with pre-existing cardiovascular or pulmonary diseases, who suddenly died after the administration of penicillin despite not exhibiting the aforementioned symptoms. It was therefore speculated that pulmonary drug micro-embolization induced a lethal cardiovascular compromise in these individuals. Histologic investigations supporting this hypothesis were performed in only one case. The diagnosis of Hoigné's pulmonary drug micro-embolization was established also in five patients with pre-existing cardiovascular or pulmonary diseases, who suddenly died after the administration of penicillin despite not exhibiting the afore mentioned symptoms. Histologic investigations supporting this hypothesis were performed in only one case. In conclusion, Hoigné's syndrome is an uncommon non-immune-mediated reaction. This report seeks to promote broader awareness and knowledge regarding this alarming mimicker of anaphylaxis. Diagnosis relies solely on clinical evaluation.
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Affiliation(s)
- Danilo Consolascio
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gabriel Bronz
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pietro F Lardelli
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Clinical Pharmacology and Therapeutics Group, University College London, London, United Kingdom
| | - Benedetta Terziroli Beretta Piccoli
- Epatocentro Ticino, Lugano, Switzerland; Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, United Kingdom; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Mario G Bianchetti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marcel M Bergmann
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Mattia Rizzi
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Pediatric Oncology/Hematology Unit, Department of Women-Mother-Child, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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4
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Urakov A, Urakova N, Samorodov A, Shabanov P, Yagudin I, Stolyarenko A, Suntsova D, Muhutdinov N. Thermal imaging of local skin temperature as part of quality and safety assessment of injectable drugs. Heliyon 2024; 10:e23417. [PMID: 38192864 PMCID: PMC10771983 DOI: 10.1016/j.heliyon.2023.e23417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Injection of high-quality drugs can occasionally cause unexpected and unexplained local complications. As the current standard for drug quality control does not include an assessment of the local irritation effects of drugs, this effect may cause postinjection complications. Simultaneously, local irritation effects of the drugs can be assessed based on local tissue inflammation. The dynamics of local temperature can assess inflammation. Infrared monitoring of local skin temperature dynamics at subcutaneous, intramuscular, and intravenous injection sites of drugs under experimental and clinical conditions can improve their quality and safety. Therefore, there is a need to include dynamic thermography in the standard of biological evaluation of the quality and safety of drugs in the dosage form "solution for injections." This eliminates the local irritation and necrotizing activity of drugs and minimizes the development of local pain syndrome, aseptic inflammation, necrosis, and abscess.
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Affiliation(s)
- Aleksandr Urakov
- Department of General and Clinical Pharmacology, Izhevsk State Medical University, Izhevsk, Russia
- Department of Inventions and Patents, Institute of Thermology, Izhevsk, Russia
| | - Natalya Urakova
- Department of General and Clinical Pharmacology, Izhevsk State Medical University, Izhevsk, Russia
- Department of Inventions and Patents, Institute of Thermology, Izhevsk, Russia
| | | | - Petr Shabanov
- Department of Neuropharmacology, Institute of Experimental Medicine, Saint Petersburg, Russia
| | - Ilnur Yagudin
- Department of General and Clinical Pharmacology, Izhevsk State Medical University, Izhevsk, Russia
| | - Anastasia Stolyarenko
- Department of General and Clinical Pharmacology, Izhevsk State Medical University, Izhevsk, Russia
| | - Darya Suntsova
- Department of General and Clinical Pharmacology, Izhevsk State Medical University, Izhevsk, Russia
| | - Nikita Muhutdinov
- Department of General and Clinical Pharmacology, Izhevsk State Medical University, Izhevsk, Russia
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5
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Amorim RO, Silva ALCCD, Seque CA, Porro AM. Extensive Nicolau syndrome following intramuscular diclofenac sodium injection. An Bras Dermatol 2024; 99:123-125. [PMID: 37743206 DOI: 10.1016/j.abd.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 09/26/2023] Open
Affiliation(s)
| | | | - Camila Arai Seque
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Adriana Maria Porro
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Akdogan N, Elcin G, Kiraz S. Bizarre Cutaneous Ulcers due to Self-Administered Intravenous Dexketoprofen Trometamol. INT J LOW EXTR WOUND 2023; 22:788-791. [PMID: 35037506 DOI: 10.1177/15347346221074158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Systemic non-steroidal anti-inflammatory drug use may result in various cutaneous complications including maculopapular rash, fixed drug eruption, urticaria, and angioedema most frequently. However extensive cutaneous ulcers in relation to intravenous dexketoprofen trometamol use has not been identified before although cutaneous ulcers have been described in association with several opioids. Herein, we would like to present a 27-year-old male with a 1-year history of progressive deep cutaneous ulcers due to long term abusive intravenous use of dexketoprofen trometamol.
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Goli R, Faraji N, Janghiyamachi R, Talebiazar N. Nicolau syndrome after intramuscular injection of methocarbamol: A rare case report. Toxicol Rep 2023; 11:346-348. [PMID: 37859670 PMCID: PMC10582772 DOI: 10.1016/j.toxrep.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
Background Methocarbamol is a muscle relaxant medication that is commonly used to treat muscle spasms and musculoskeletal pain. Methocarbamol intramuscular injection can cause necrosis of the soft tissue. This rare condition can create severe adverse event with permanent disability. Case presentation A 32-year-old woman with no significant past medical history presented to the emergency department with severe pain, redness, and swelling involving her left buttock and the surrounding back area. Clinical discussion The necrotic changes due to methocarbamol intramuscular injection can progress rapidly, leading to the formation of deep ulcers, cellulitis, and even abscesses. Prompt recognition and intervention are crucial to prevent further tissue damage and complications. Conclusion Comprehending the fundamental mechanisms and identifying risk factors related to this complication is imperative in enabling healthcare professionals to proficiently manage and avert its manifestation.
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Affiliation(s)
- Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Razieh Janghiyamachi
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University, Marand Branch, Tabriz, Iran
| | - Nasim Talebiazar
- Department of Psychiatric, Urmia University of Medical Sciences, Urmia, Iran
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Fekete GL, Iantovics LB, Fekete JE, Fekete L. Embolia cutis Medicamentosa (Nicolau syndrome): case series. Front Med (Lausanne) 2023; 10:1216781. [PMID: 38020151 PMCID: PMC10653301 DOI: 10.3389/fmed.2023.1216781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Embolia cutis medicamentosa or Nicolau syndrome is a rare drug reaction associated with the administration of various injectable medications. The pathogenesis of the disease is unknown, though intra and periarterial injection of the drug is a possible cause. The aim of this study was to describe and analyze the clinical characteristics of Nicolau syndrome in patients examined in daily dermatological practice. Methods We performed a retrospective chart review, between January 2011 and December 2020, in patients diagnosed with Nicolau syndrome, from the cases of a private dermatology medical office in Târgu Mureș, Romania. Results During the 10-year period, 7 patients were diagnosed with Nicolau syndrome. Of these, 4 (57%) patients were males and 3 (43%) were females, The male to female ratio was 1.33. The median age was 64 (interquartile range, IQR, 62-71), with the youngest patient being diagnosed at age 61 and the oldest at age 74. Regarding the drugs classes that caused Nicolau syndrome, these were intravenous antibiotics in 57%, and non-steroidal anti-inflammatory drugs in 43% of cases. Conclusion All patients healed in a period of 6 to 8 weeks. No complications occurred. In conclusion, Nicolau syndrome is a rare side effect of injectable drug administration.
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Affiliation(s)
- Gyula Laszlo Fekete
- Department of Dermatology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
- CMI Dermamed Private Medical Office, Targu Mures, Romania
| | - Laszlo Barna Iantovics
- Department of Electrical Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Júlia Edit Fekete
- National Institute of Public Health, Regional Center for Public Health, Targu Mures, Romania
| | - Laszlo Fekete
- CMI Dermamed Private Medical Office, Targu Mures, Romania
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
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Urakov AL, Urakova NA, Shubina ZV, Lovtsova LV, Samorodov AV, Gurevich KG, Stolyarenko AP, Korunas VI, Lipatov DO, Muminov DD. Hypertonic Activity of Injection Solutions Can Cause Post-injection Complications (Review). DRUG DEVELOPMENT & REGISTRATION 2023; 12:164-173. [DOI: 10.33380/2305-2066-2023-12-2-164-173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Introduction. A review of the scientific literature showed that the current standards for assessing the quality of drugs does not include an assessment of the osmotic activity of drug solutions and their local irritant effect on tissues at the sites of subcutaneous, intramuscular and intravenous injections. Therefore, currently injectable solutions considered to be of high quality may not have isotonic activity and high postinjection safety.Text. A study of the concentration range of quality drug solutions ready for injection showed that the acceptable concentration value of the main ingredients is in the range of 0.01 to 76 %. Direct measurement with an osmometer of the osmotic activity of injection solutions, considered qualitative today, has shown that injection solutions can have hypotonic, isotonic and hypertonic activity and their osmotic activity can be in the range of 0 – 3900 mosmol/l water. Study of acidic activity of drug solutions showed that in accordance with pharmacopoeial requirements of drug quality modern quality drug solutions ready for injection can have acidic, neutral or alkaline activity. Solutions with hypertonic activity have been found to have a local irritant effect. Moreover, an increase in hypertonic activity of drug solutions increases their local irritant effect. It has been found that excessively high hypertonic activity of drug solutions may be the cause of the development of a local postinjection complication known as "Nicolaou syndrome", the cause of which has remained unknown for a long time. Nicolaou syndrome includes local pain syndrome, aseptic inflammation, necrosis, and abscess.Conclusion. The authors conducted a literature review, the results of which led to conclusions and assumptions. Solutions containing drugs in concentrations greater than 10 % may have the highest hypertonic activity, which can cause excessive dehydrating, local irritating and cauterizing effects. Therefore, injections of such drugs are most dangerous with the development of post-injection necroses and abscesses. That is why timely dilution of concentrated drug solutions with water by 2–10 times increases injection safety. It is proposed to include the assessment of osmotic activity and local irritant effect of drug solutions in the standard of drug quality control.
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Affiliation(s)
- A. L. Urakov
- Federal State Budgetary Institution of Science "Udmurt Federal Research Center of the Ural Branch of the Russian Academy of Sciences"; Izhevsk State Medical Academy
| | | | | | | | | | - K. G. Gurevich
- Federal State Budgetary Educational Institution of Higher Education "Yevdokimov A. I. Moscow State University of Medicine and Dentistry" of the Ministry of Healthcare of the Russian Federation
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Santos BC, Correia RM, Kuramoto DAB, Carvalho AAG, Avila RB, Amorim JE, Flumignan RLG, Nakano LCU. Nicolau syndrome or 'embolia cutis medicamentosa' in a newborn: successful treatment with a surgical intervention. Arch Dis Child Fetal Neonatal Ed 2022; 107:648. [PMID: 33972262 DOI: 10.1136/archdischild-2021-321637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/15/2021] [Accepted: 04/19/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Brena Costa Santos
- Division of Vascular and Endovascular Surgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Rafael Bernardes Avila
- Division of Vascular and Endovascular Surgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Jorge Eduardo Amorim
- Division of Vascular and Endovascular Surgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Luis Carlos Uta Nakano
- Division of Vascular and Endovascular Surgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Ziesenitz VC, Welzel T, van Dyk M, Saur P, Gorenflo M, van den Anker JN. Efficacy and Safety of NSAIDs in Infants: A Comprehensive Review of the Literature of the Past 20 Years. Paediatr Drugs 2022; 24:603-655. [PMID: 36053397 PMCID: PMC9592650 DOI: 10.1007/s40272-022-00514-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in infants, children, and adolescents worldwide; however, despite sufficient evidence of the beneficial effects of NSAIDs in children and adolescents, there is a lack of comprehensive data in infants. The present review summarizes the current knowledge on the safety and efficacy of various NSAIDs used in infants for which data are available, and includes ibuprofen, dexibuprofen, ketoprofen, flurbiprofen, naproxen, diclofenac, ketorolac, indomethacin, niflumic acid, meloxicam, celecoxib, parecoxib, rofecoxib, acetylsalicylic acid, and nimesulide. The efficacy of NSAIDs has been documented for a variety of conditions, such as fever and pain. NSAIDs are also the main pillars of anti-inflammatory treatment, such as in pediatric inflammatory rheumatic diseases. Limited data are available on the safety of most NSAIDs in infants. Adverse drug reactions may be renal, gastrointestinal, hematological, or immunologic. Since NSAIDs are among the most frequently used drugs in the pediatric population, safety and efficacy studies can be performed as part of normal clinical routine, even in young infants. Available data sources, such as (electronic) medical records, should be used for safety and efficacy analyses. On a larger scale, existing data sources, e.g. adverse drug reaction programs/networks, spontaneous national reporting systems, and electronic medical records should be assessed with child-specific methods in order to detect safety signals pertinent to certain pediatric age groups or disease entities. To improve the safety of NSAIDs in infants, treatment needs to be initiated with the lowest age-appropriate or weight-based dose. Duration of treatment and amount of drug used should be regularly evaluated and maximum dose limits and other recommendations by the manufacturer or expert committees should be followed. Treatment for non-chronic conditions such as fever and acute (postoperative) pain should be kept as short as possible. Patients with chronic conditions should be regularly monitored for possible adverse effects of NSAIDs.
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Affiliation(s)
- Victoria C. Ziesenitz
- grid.5253.10000 0001 0328 4908Pediatric Cardiology and Congenital Heart Diseases, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany ,grid.6612.30000 0004 1937 0642Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Tatjana Welzel
- grid.6612.30000 0004 1937 0642Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Basel, Switzerland ,grid.411544.10000 0001 0196 8249Pediatric Rheumatology and Autoinflammatory Reference Center, University Hospital Tuebingen, Tuebingen, Germany
| | - Madelé van Dyk
- grid.1014.40000 0004 0367 2697Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Patrick Saur
- grid.5253.10000 0001 0328 4908Pediatric Cardiology and Congenital Heart Diseases, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Matthias Gorenflo
- grid.5253.10000 0001 0328 4908Pediatric Cardiology and Congenital Heart Diseases, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Johannes N. van den Anker
- grid.6612.30000 0004 1937 0642Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Basel, Switzerland ,grid.239560.b0000 0004 0482 1586Division of Clinical Pharmacology, Children’s National Hospital, Washington DC, USA ,grid.416135.40000 0004 0649 0805Intensive Care and Department of Pediatric Surgery, Sophia Children’s Hospital, Rotterdam, The Netherlands
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12
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Ciprian S, Lava SAG, Milani GP, Bianchetti MG, Consolascio D, Lardelli PF. Nicolau syndrome caused by Glatiramer. Mult Scler Relat Disord 2022; 57:103365. [PMID: 35158471 DOI: 10.1016/j.msard.2021.103365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/17/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022]
Abstract
Injection-site reactions to glatiramer are common and include erythema, pruritus, pain, or induration. Additionally, the present systematic review of the literature documents 20 cases of Nicolau syndrome following glatiramer, a rare but potentially severe skin reaction. Abdomen and thighs are the most frequently affected areas (80% of reported cases), and permanent skin damage has been observed in 30% of cases. Recurrences are rare (<10%).
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Affiliation(s)
- Sandro Ciprian
- Pediatric Cardiology Unit, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Mario G Bianchetti
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Pediatric Institute of Southern Switzerland EOC, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Danilo Consolascio
- Family Medicine Institute, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro F Lardelli
- Family Medicine Institute, Università della Svizzera Italiana, Lugano, Switzerland
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