Coincidence of Nicolau Syndrome and Rhabdomyolysis: Report of a Forensic Autopsy Case and Review of the Literature |
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| Authors: | Murat Nihat Arslan M.D. Deniz Oguzhan Melez M.D. Arzu Akcay M.D. Adem Gur M.D. Bulent Sam M.D. Suheyla Guven Apaydın M.D. |
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| Affiliation: | 1. Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey;2. Additional information and reprint requests:;3. Murat Nihat Arslan, M.D.;4. Adli Tip Kurumu Baskanligi;5. Cobancesme Mah, Kimiz Sok No:1 34196;6. Bahcelievler‐Istanbul;7. Turkey;8. E‐mail:;9. Haydarpasa Numune Teaching Hospital, T?bbiye Cad. No:23 Uskudar 34668 Istanbul, Turkey |
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| Abstract: | Nicolau syndrome (NS) is a dermatological adverse reaction of intramuscular injections and is caused by several mechanisms. The etiopathogenesis remains unclear, and several hypotheses have suggested a vascular origin. Rhabdomyolysis (RM) is the destruction of striated muscle, with the subsequent release of muscle cell contents into circulation. NS and RM diagnoses may overlap. Herein, we present the autopsy findings of a 40‐year‐old female with NS complicated with RM. On clinical follow‐up, creatine kinase (CK) was 7146 IU/L, and urea and creatinine levels were elevated on the third day after intramuscular diclofenac injection. Possible ischemic process triggered the RM and subsequent acute renal failure. The opportunity for an early diagnosis was missed because the patient delayed seeking medical aid. The prognosis worsened, and the patient died due to secondary sepsis. Early diagnosis of NS before the occurrence of complications is the most important issue in patient education and can be life‐saving. |
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| Keywords: | forensic science Nicolau syndrome diclofenac intramuscular injection rhabdomyolysis autopsy |
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