Ayurveda management of Nicolau syndrome W.S.R to Kotha – a case report

Administration of intramuscular, intraarterial or subcutaneous injection of particular drugs ends up into a rare entity known as Nicolau syndrome (NS). The viscous nature of these drugs sometimes triggers acute vasospasm and even arterial embolism. There is no consensus on treatment of NS so far. Phasic treatments depend on the extent of the necrotic lesion and ranges from medication to surgical debridement. Here we report a case of 60 year female known case of Knee Osteoarthritis who was dependent on Diclofenac injection IM for relief of pain. She presented with complaints of fever with chills, rigors, discoloration of skin at the gluteal region right side, later turned into necrosis of skin and adipose tissue, pus formation and associated with loss of appetite, dryness of mouth, pedal oedema. The case was diagnosed as NS according to contemporary science and Kotha (Gangrene) as per Ayurveda. The case was treated successfully with Chedana karma (Surgical debridement) followed by Vrana shodhana (making free from undesirable healing factors), Ropana (Closure of wound) and oral medications.