ABSTRACT
Nicolau syndrome (NS) is a rare complication of an intramuscular injection characterized by severe pain, skin discoloration, and varying levels of tissue necrosis. The case outcomes vary from atrophic ulcers and severe pain to sepsis and limb amputation. We describe a case of a seven-year-old boy with diagnosis of NS after intramuscular benzathine penicillin injection to the ventrolateral aspect of the left thigh. Characteristic violaceous discoloration of skin and immediate injection site pain identified it as a case of NS. The case was complicated by rapid progression of compartment syndrome of the lower limb, proceeding to acute renal failure and death. Associated compartment syndrome can be postulated as a poor prognostic factor for NS.
Subject(s)
Child , Compartment Syndromes/etiology , Drug Eruptions/complications , Fatal Outcome , Humans , Injections, Intramuscular/adverse effects , Acute Kidney Injury/etiology , Male , Pain/chemically induced , Penicillin G Benzathine/administration & dosage , Skin Diseases, Vascular/chemically induced , Skin Pigmentation/drug effects , Syndrome , ThighABSTRACT
A 28 year old male presented with fever, tachycardia, generalized lymphadenopathy and diffuse rash over the body. He failed to respond to intravenous antibiotics and developed cardiogenic shock, multiple organ failure and died within six hours after hospitalization. Staphylococcus aureus colonies were revealed on blood culture.
Subject(s)
Adult , Anti-Bacterial Agents/therapeutic use , Cardiotonic Agents/therapeutic use , Ceftriaxone/therapeutic use , Dopamine/therapeutic use , Fatal Outcome , Humans , Male , Shock, Septic/complications , Staphylococcal Infections/complicationsABSTRACT
A 15 year-old-male presented with concurrent sinonasal polyposis and anterior uveitis with cervical lymph node enlargement. Cervical lymph node biopsy confirmed Rosai-Dorfman disease. Though patient's eye symptoms did not respond well to topical corticosteroid treatment but he showed a remarkable regression in the size of nasal polyps and cervical lymph nodes after systemic corticosteroids. Intraocular involvement in such a case is rare.
Subject(s)
Adolescent , Biopsy, Needle , Diagnosis, Differential , Histiocytosis, Sinus/diagnosis , Humans , Lymph Nodes/pathology , Male , Nasal Mucosa/microbiology , Nasal Polyps/surgery , Neck/pathology , Paranasal Sinuses/pathologyABSTRACT
Pharmacoeconomics plays a pivotal role in clinical practice. High medicine prices can adversely affect a patient's finances and compliance. The Indian pharmaceutical industry has become a cornucopia of medicines with wide variation in prices for the same medicine marketed under different brand names. Price list of available antimicrobial brands was procured from a commercial drug directory. Average price of widely prescribed oral antimicrobials was found and price variation between different brands was calculated. The variation in medicine prices was found to be from 95% lower to more than 350% higher than the average price. Implications of price variation in clinical practice are discussed and remedial measures suggested.