Embolia cutis Medicamentosa (Nicolau syndrome): case series

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.

Multiple nodular cutaneous metastases as the first clinical sign of signet ring cell gastric carcinoma: case report

Cutaneous metastases from signet ring cell gastric carcinoma are uncommon. A 35-year-old male presented with a three-month history of multiple asymptomatic, indurated, pinky colored nodules of 2.5 to 4 cm in diameter, without any local and general symptoms. Nodule biopsy revealed an infiltrating signet ring cell carcinoma. Gastroscopy and biopsy confirmed the diagnosis of gastric carcinoma with signet ring cells. The present report describes an unusual clinical case of a young patient diagnosed with cutaneous metastasis before detection of his gastric carcinoma.

Steatocystoma multiplex generalisata partially suppurativa--case report

Steatocystoma multiplex is a rare inherited disorder with an autosomal dominant mode of transmission, but sometimes it may appear sporadically. Usually the onset tends to occur during adolescence or early adult life. A clinical case of a 27-year-old male patient is presented. Since the age of 8, he had been presenting with multiple, asymptomatic, round-to-oval, well-defined, smooth-surfaced, yellow to skin-colored, 5- to 22-mm diameter cysts and nodules initially scattered on the trunk and lately disseminated all over the body with less lesions on the lower extremities. At one of follow-up visits, he presented with high fever, pain with tumefaction of the small and medium size joints of the palms and soles, and deteriorated general status with polymorphous skin lesions. Based on the clinical and paraclinical features, the diagnosis of steatocystoma multiplex generalisata partially suppurativa was made. He was treated with oral isotretinoin (1 mg/kg per day) for 14 weeks, antibiotics and local treatments. The lesions healed slowly, with local disfigurement, hyperpigmentation and unpleasant scars. Isotretinoin usually does not eradicate the condition but could be effective in suppurative abscesses. Steatocystoma multiplex generalisata is considered rare; the true incidence of the disease is unknown. In the disease evolution, the severe inflammatory variant, steatocystoma multiplex suppurativa, may appear at any time.