Can Ege YALCIN, Melih Kaan SARIDAL, Omer Faruk DILBAZ, Ilker USCETIN
Turkish Journal of Plastic Surgery - 2026;34(1):28-38
Background: Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare iatrogenic complication characterized by acute ischemic necrosis of the skin and subcutaneous tissues following parenteral injections. While it has been reported with a variety of injectable agents, pediatric cases remain uncommon and poorly characterized. Methods: A structured review of the literature was conducted to identify published pediatric cases of Nicolau syndrome. Reports were screened using predefined search terms across major medical databases, and relevant clinical, etiologic, and outcome data were extracted for descriptive analysis. Results: A total of 42 pediatric cases reported in 33 publications were identified. The mean age at presentation was approximately 5 years, with a male predominance. Penicillin derivatives were the most frequently implicated agents, followed by vaccines and local anesthetics. The thigh and gluteal regions were the most common injection sites. Management strategies ranged from conservative wound care to surgical intervention, including fasciotomy and amputation in severe cases. Outcomes were heterogeneous, varying from complete recovery to permanent tissue loss. Conclusion: Nicolau syndrome represents a rare but potentially severe complication of injectable therapies in children. Awareness of characteristic clinical features, common etiologic agents, and reported management approaches may facilitate earlier recognition and improve outcomes. Our clinical experience is discussed in the context of the reviewed literature to illustrate diagnostic and therapeutic considerations in pediatric practice.
