What's the matter with injections? Nicolau syndrome

Embolia cutis medicamentosa (Nicolau syndrome) is a rare, still unexplained complication of injection of several drugs, clinically characterized by cutaneous, subcutaneous and even muscular aseptic necrosis in a livedoid pattern. Firstly described by Freudenthal and Nicolau in 1925, it typically presents with pallor, owing to a local reflex vasospasm, and pain, rapidly followed by erythema, haemorrhagic patch, blistering, and variable degree of necrosis. On pathogenesis, experimental data seem to disprove the possible allergic/immunologic pathomechanism, as well as the role of chemical–physical features of the drug, the solution pH or the injection technique.