Tissue necrosis and necrotizing fasciitis after intramuscular administration of diclofenac

OBJECTIVE: To report 6 cases of severe local reactions associated with intramuscular injection of diclofenac. CASE SUMMARIES: Three patients developed extensive tissue necrosis at the injection site after intramuscular diclofenac. Necrotizing fasciitis in an additional 3 patients was associated with complications such as adult respiratory distress syndrome, renal failure, shock, and disseminated intravascular coagulation. Organisms were cultured from the necrotic site in 3 cases. Two patients died. DISCUSSION: Tissue necrosis is a rare but serious complication of intramuscular administration of medicines, including nonsteroidal antiinflammatory drugs (NSAIDs). Pain often occurs at the time of the injection, but tissue necrosis typically becomes apparent a few days later. Necrotizing fasciitis is characterized by rapidly spreading infection with necrosis of fascia and subcutaneous fat. CONCLUSIONS: Intramuscular administration of diclofenac may be associated with severe tissue necrosis or necrotizing fasciitis. Although rare, these serious complications should be considered when intramuscular injection of NSAIDs is contemplated.

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