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Nicolau syndrome: case report A 13-year-old boy developed Nicolau syndrome (NS) following treatment with IM benzathine-benzylpenicillin injection for fever and sore throat. The boy was brought to the neurosurgical outpatient department by his physician with a 3-day history of weakness of the left lower limb following a left gluteal IM injection of benzathine-benzylpenicillin[benzathine-penicillin; dosage not stated] for fever and sore throat. He revealed an onset of weakness in both lower limbs within 1 hour after the injection. Additionally, urinary and fecal incontinence was also observed for short term which had recovered completely by the second day. He had not experienced any radicular pain during or after the injection. Local examination of the gluteal region showed multiple ecchymoses extending to the back of the thigh. He also had left lower limb swelling. Clinical examination showed left foot drop and mild weakness of both lower limbs with a power of 4 of 5. The sensations were reduced in the left common peroneal distribution. He also had sustained accidental burns to his left toe. At the time of the evaluation, the perianal sensation was normal. On day 20, nerve conduction studies showed severe axonopathy involving the left common peroneal, posterior tibial, and sural nerves and mild axonopathy of the right common peroneal nerve. The ultrasound scan revealed mild subcutaneous swelling. Haematomas or localised collections were not seen. Based on the unusual clinical and electrophysiological features, he was diagnosed with Nicolau syndrome. The boy was treated with prednisone, which was tapered over the next 2 weeks. He also underwent regular conventional muscle strengthening physiotherapy and intermittent electrical muscle stimulation therapy. During the next few weeks, he showed significant clinical recovery. At the 6 month follow-up, his left foot drop had almost completely recovered, with spontaneous resolution of skin changes. Raju B, et al. Nicolau Syndrome, Masquerader of Postinjection Sciatic Nerve Injury: Case Report and Review of Literature. World Neurosurgery 143: 51-55, Nov 2020. 803501688 Available from: URL: http://doi.org/10.1016/j.wneu.2020.07.029

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Reactions 19 Sep 2020 No. 1822