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      Ischémie aiguë de membre sévère sanctionnée par désarticulation de sauvetage dans un contexte de syndrome de Nicolau suite à une injection intramusculaire de pénicilline: à propos d’un cas Translated title: Severe acute limb ischemia resulting in rescue disarticulation in a patient with Nicolau syndrome following intramuscular penicillin injection: a case report

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          Abstract

          Nous décrivons le cas d'un enfant de 9 ans qui a présenté une ischémie aiguë sévère de membre dans un contexte de syndrome de Nicolau du membre pelvien gauche faisant suite à une injection intramusculaire glutéale de benzathine-pénicilline. Outre la rareté de l'ischémie aiguë de membre chez l'enfant, la particularité de ce syndrome de Nicolau compliqué associant une thrombose artérielle aiguë et d'une rhabdomyolyse sévère ayant conduit à une désarticulation de sauvetage de la hanche font l'intérêt de ce cas.

          Translated abstract

          We here report the case of a 9-year-old child suffering from Nicolau syndrome involving the left pelvic limb with severe acute limb ischemia following intramuscular benzathine penicillin injection into the buttock. Given the rarity of acute limb ischemia in children, this case of complicated Nicolau syndrome combining acute arterial thrombosis and severe rhabdomyolysis leading to rescue hip dislocation is very interesting.

          Most cited references6

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          Nicolau Syndrome: three cases and review.

          Nicolau Syndrome, also known as livedo-like dermatitis (LLD) or embolia cutis medicamentosa (ECM) is an infrequent complication following intramuscular and intra-articular injection of various drugs. This rare entity is characterized by severe pain and erythematous-ecchymotic reticular lesions at the injection site, which in many cases lead to necrotic ulcers and scarring. We report three cases of Nicolau Syndrome following injection of diclofenac, penicillin G, and cyanocobalamin.
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            Approaches to Improving Adherence to Secondary Prophylaxis for Rheumatic Fever and Rheumatic Heart Disease: A Literature Review with a Global Perspective.

            Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune conditions resulting from infection with group A streptococcus. Current management of these conditions includes secondary antibiotic prevention. This comprises regular 3 to 4 weekly long-acting intramuscular benzathine penicillin injections. Secondary antibiotic prevention aims to protect individuals against reinfection with group A streptococcus, thereby preventing recurrent ARF and the risk of further damage to the heart valves. However, utilization of benzathine penicillin can be poor leaving patients at risk of avoidable and progressive heart damage. This review utilizes the Chronic Care Model as a framework to discuss initiatives to enhance the delivery of secondary antibiotic prophylaxis for ARF and RHD. Results from the search strategy utilized revealed that there is limited pertinent published evidence. The evidence that is available suggests that register/recall systems, dedicated health teams for delivery of secondary antibiotic prophylaxis, education about ARF and RHD, linkages with the community (particularly between health services and schools), and strong staff-patient relationships may be important. However, it is difficult to generalize findings from individual studies to other settings and high quality studies are lacking. Although secondary antibiotic prophylaxis is an effective treatment for those with ARF or RHD, the difficulties in implementing effective programs that reduce the burden of ARF and RHD demonstrates the importance of ongoing work in developing and evaluating research translation initiatives.
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              Anticoagulant and vasodilator therapy for Nicolau syndrome following intramuscular benzathine penicillin injection in a 4 year old boy.

              Nicolau syndrome (NS) is a rare complication of intramuscular, intraarticular or subcutaneous injection of particular drugs leading to ischemic necrosis of the surrounding skin, soft tissue and muscular tissue. Benzathine penicilin one of the most widely used antibiotic for upper respiratory tract infections and has been rarely reported to cause NS. Here we describe a 4 year old boy with diagnosis of NS after the injection of benzathine penicillin who was successfuly treated with unfractionized heparin (enoxaparine) and pentoxifylline. The practitioners should pay attention for unnecessary use of benzathine penicillin to avoid from probable complications.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                24 December 2020
                2020
                : 37
                : 378
                Affiliations
                [1 ]Service de Cardiologie, Centre Hospitalier Universitaire Sourou Sanou, Bobo-Dioulasso, Burkina Faso,
                [2 ]Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso,
                [3 ]Service d'Orthopédie Traumatologie, Centre Hôspitalier Universitaire Sourou Sanou, Bobo-Dioulasso, Burkina Faso,
                [4 ]Service de Dermatologie, Centre Hôspitalier Universitaire Sourou Sanou, Bobo-Dioulasso, Burkina Faso,
                [5 ]Unité de Recherche et de Formation en Sciences de la Santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
                Author notes
                Corresponding author: Somnoma Jean-Baptiste Tougouma, Service de Cardiologie, Centre Hospitalier Universitaire Sourou Sanou, Bobo-Dioulasso, Burkina Faso. tougjb@ 123456yahoo.fr
                Article
                PAMJ-37-378
                10.11604/pamj.2020.37.378.21384
                7992423
                8a119959-f7fd-4ea8-af23-6c1f860f37c9
                Copyright: Somnoma Jean-Baptiste Tougouma et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 December 2019
                : 06 April 2020
                Categories
                Case Report

                Medicine
                ischémie aiguë de membre,enfant,syndrome de nicolau,benzathine benzylpénicilline,case report,acute limb ischemia,child,nicolau syndrome,benzathine penicillin

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