Drug reactions: Nicolau syndrome: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Drug reactions: Nicolau syndrome

Sample item

Minutes after an intramuscular diclofenac injection in the buttock, a patient has severe pain. A livedoid violaceous patch appears and over days becomes a necrotic ulcer. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Nicolau syndrome

Nicolau syndrome (embolia cutis medicamentosa) follows an injection, with immediate pain, livedoid change and then necrosis from vascular compromise. Injection technique should be reviewed, and care is supportive.

Option by option

  • A. Fixed drug eruption

    A fixed drug eruption is a round dusky patch that recurs at the same site after oral exposure.

  • B. Stevens-Johnson syndrome

    SJS is a diffuse mucocutaneous eruption 1 to 3 weeks after starting a drug.

  • C. Nicolau syndrome (correct)

    Correct. Immediate pain with a livedoid patch evolving into necrosis after an injection is Nicolau syndrome.

  • D. Cellulitis

    Cellulitis develops over a day or more with fever and a spreading warm red area.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Dermatology questions

Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is C, Nicolau syndrome. Nicolau syndrome (embolia cutis medicamentosa) follows an injection, with immediate pain, livedoid change and then necrosis from vascular compromise.

Why is "Fixed drug eruption" not the answer?

A fixed drug eruption is a round dusky patch that recurs at the same site after oral exposure.

Why is "Stevens-Johnson syndrome" not the answer?

SJS is a diffuse mucocutaneous eruption 1 to 3 weeks after starting a drug.

Why is "Cellulitis" not the answer?

Cellulitis develops over a day or more with fever and a spreading warm red area.

What concept does this question test?

It tests Drug reactions: Nicolau syndrome in Dermatology. Injection technique should be reviewed, and care is supportive.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Drug reactions: Nicolau syndrome?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.