RESUMO
Nicolau syndrome is a rare condition characterized by severe pain at the site of injection, leading to ulceration and necrosis of the local tissues. Its presentation is usually acute. Nicolau syndrome is commonly seen in patients after intramuscular, intra-articular, or subcutaneous injections of non-steroidal anti-inflammatory drugs, antiepileptics, antipsychotics, antibiotics, antihistamines, and corticosteroids. Immediate diagnosis and management of this syndrome are of great importance. We herein report a rare presentation of Nicolau syndrome in a 36-year-old married male who suffered from paranoid schizophrenia for the past 3 years. The patient presented with dull pain, mild swelling, and necrotic ulceration over the injection site after receiving intramuscular fluphenazine. The patient underwent wound debridement and was given prophylactic antibiotics. Despite a wide range of therapeutic options for the management of Nicolau syndrome described in the literature, there exist limited guidelines for its management.
RESUMO
Strokes are the second leading cause of death and disability worldwide. The brain injury resulting from stroke produces a persistent neuroinflammatory response in the brain, resulting in a spectrum of neurologic dysfunction affecting stroke survivors chronically, also known as post-stroke pain. Excess production of tumor necrosis factor alpha (TNF alpha) in the cerebrospinal fluid (CSF) of stroke survivors has been implicated in post-stroke pain. Therefore, this literature review aims to assess and review the role of perispinal etanercept in the management of post-stroke pain. Several studies have shown statistically significant evidence that etanercept, a TNF alpha inhibitor, can reduce symptoms present in post-stroke syndrome by targeting the excess TNF alpha produced in the CSF. Studies have also shown improvements in not only post-stroke pain but also in traumatic brain injury and dementia. Further research is needed to explore the effects of TNF alpha on stroke prognosis and determine the optimal frequency and duration of etanercept treatment for post-stroke pain.
RESUMO
La esclerodermia es una enfermedad sistémica-crónica que afecta la piel y órganos como el esófago, en un 80%; se inicia en el tercer o cuarto decenio de vida y es dos veces más frecuente en mujeres. El diagnóstico de esclerodermia esofágica se establece mediante estudios manométricos por la presencia de peristalsis normal en la parte proximal del esófago estriada, con ausencia de la misma en la parte distal de músculo liso.En el esófago se manifiesta una esofagitis péptica crónica que raramente produce complicaciones letales como el sangrado masivo ocurrido en el presente caso clínico.
The scleroderma is a systemic chronic disease that affects skin and the rest of the organs like the esophagus in 80% of the cases. It usually affects woman in the third or fourth decade of life. The diagnosis of scleroderma in the esophagus can be determined by performing and esohageal manometry to study the muscular contraction of proximal part of the esophagus and its abscense of distal part.A chronic peptic esophagitis is the clinical manifestation of scleroderma. It rarely produces lethal complications like massive hemorrhage which occurred in this clinical case.