Effective Treatment of Nicolau Syndrome Induced by Etofenamate Injection Using Hyperbaric Oxygen Therapy

Nicolau syndrome (NS) is a rare but serious iatrogenic complication characterized by cutaneous necrosis following intramuscular injections. Hyperbaric oxygen therapy (HBOT) has shown promise in enhancing tissue oxygenation and promoting wound healing in NS cases. The authors report the case of a 51-year-old female who developed a painful necrotic ulcer on her left gluteal region, diagnosed as NS following an intramuscular injection of etofenamate administered for knee osteoarthritis. The patient was treated with a combination of local wound care and a series of 30 HBOT sessions. This treatment regimen led to complete ulcer healing with residual hypopigmented scarring. Hyperbaric oxygen therapy can be an effective treatment for NS induced by intramuscular etofenamate injection, facilitating complete ulcer healing and minimizing sequelae. This case underscores the importance of early recognition and comprehensive management of NS, including the potential benefits of HBOT.