Complication d’une injection intramusculaire ou syndrome de Nicolau

RésuméNous décrivons le cas d’un adolescent de 14 ans qui a présenté un syndrome de Nicolau du membre inférieur droit. Ce syndrome faisait suite à une injection intramusculaire glutéale homolatérale de benzathine-pénicilline associée à de la lidocaïne, liée à une suspicion de rhumatisme articulaire aigu. Outre la rareté de ce syndrome, nous rapportons une association particulière à une torsion testiculaire aiguë.

SummaryNicolau syndrome is a rare, potentially severe complication that may occur after any drug injection, particularly after intramuscular injection. It is characterized by the acute onset of cutaneous and soft-tissue aseptic necrosis. Here, we report the case of a 14-year-old boy diagnosed with Nicolau syndrome on the right lower limb, after a benzathine-penicillin intramuscular injection for suspected rheumatic fever. The short-term progression was marked by uncomplicated rhabdomyolysis and the constitution of homolateral testicular torsion. The cutaneous-muscular disorders evolved favorably under symptomatic treatment. We discuss this insufficiently known complication of intramuscular injection, which may motivate reduced use of this route of drug administration in children and strict adherence to the procedure. Furthermore, it is important to note that Nicolau syndrome may evolve to homolateral testicular torsion, as, to the best of our knowledge, is reported for the first time in this case.