Embolia Cutis Medicamentosa Secondary to Commonly used Drugs: A Series of Four Cases

Nicolau syndrome, also referred to as Embolia Cutis Medicamentosa, is a rare iatrogenic complication typically following intramuscular, subcutaneous, or intra-articular drug administration. It is characterised by the sudden onset of severe pain, followed by erythema, violaceous discoloration, and skin necrosis at the injection site. This report presents a case series of four patients aged 13, 30, 43, and 56 years, who developed Nicolau syndrome after intramuscular injections of commonly used drugs such as Deriphyllin, Diclofenac, Tramadol, and Betamethasone. The clinical presentation in all cases involved acute pain followed by ulceration or necrosis over the gluteal region. Diagnosis was primarily clinical, supported by normal laboratory parameters and ultrasonographic findings showing subcutaneous tissue changes. Management included conservative approaches such as wound care with topical antibiotics, systemic analgesics, and oral antibiotics as needed. All patients recovered with residual scarring and post-inflammatory hyperpigmentation. This case series emphasises the importance of correct injection techniques, including appropriate site selection (upper outer quadrant of the buttock), using the Z-track method, aspirating before injection, and employing appropriate needle lengths to minimise risk. Given that Embolia Cutis Medicamentosa is preventable, reporting such cases is crucial to raise awareness among healthcare professionals. Early diagnosis and appropriate intervention can significantly reduce the complications and morbidity associated with this condition.