Nicolau syndrome after lumbar puncture: A case report in a 22-month-old girl

Nicolau syndrome (NS) is a rare, aseptic cutaneous necrosis that may involve the subcutaneous and muscle tissue layers.1 This syndrome is associated with intramuscular, subcutaneous, intravenous, and intra-articular injections of antibiotics, local anesthetics, glucocorticoids, nonsteroidal anti-inflammatory drugs, hyaluronic acid, vaccinations, and vitamins.2, 3, 4, 5 NS presents as an immediate and severe pain at the injection site and a clearly demarcated livedolike discoloration of the skin that progresses to cutaneous necrosis with potential involvement of the underlying tissues.2, 3 Although the pathophysiology of NS is debated, multiple theories implicate occlusion of cutaneous vessels after iatrogenic insult as an inciting cause.1, 2 Here, we present the first case, to our knowledge, of NS caused by lumbar puncture.