Extensive Nicolau Syndrome Following Intramuscular Injection of Paracetamol in a Patient Who Is HIV Positive.

Nicolau syndrome (NS) is a type of adverse skin reaction occurring after parenteral drug injection. In certain conditions, it can cause ischemic necrosis of the skin and the underlying adipose tissue. The actual cause of NS is not clear though inflammation, vasospasm, and thromboembolic occlusion of blood vessels have been proposed. In this case presentation, we report an interesting case of a 30-year-old man who turned out be human immunodeficiency virus (HIV) positive on investigations, developed extensive purpuric lesions of his skin on left buttock and then spread to the trunk and shoulders after receiving intramuscular injection of paracetamol. With a suggestive history and further supported by clinical examination, a diagnosis of NS following injection of paracetamol was made. Though NS is considered to be rare, at times it can be devastating. Being a common procedure in the life of a health-care professional, the awareness regarding this entity is very essential. Despite intense medical literature search in, we could not find a single report of NS after intramuscular injection of paracetamol in a patient who is HIV positive, thus obliging this communication.