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[Severe pain and skin discolouration after injection: Nicolau syndrome, a rare complication].

BACKGROUND Parenteral administration of medication is a frequent practice, but in rare cases, serious complications may occur. CASE DESCRIPTION A 33-year-old man experienced intense pain in his forearm immediately after administration of clemastine through a Venflon in his elbow crease. The pain was accompanied by white discolouration of some fingers and livid discolouration of the skin between the fingers. This reaction is typical for Nicolau syndrome, a rare skin reaction that may develop after intramuscular or intra-arterial administration of medication. Aetiology is unclear, but vascular spasms, blood vessel wall damage and thrombosis are the most important factors. Treatment consists of minimising complications. CONCLUSION In the worst cases of Nicolau syndrome, extensive necrosis and permanent injury may occur. It is important to recognise the symptoms. Preventing or minimising tissue necrosis is essential and attention should be paid to pain relief. Proper injection methods can prevent the occurrence of this syndrome.