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 intra muscular diclofenac. Necrotizing fasciitis in an additional 3 patients was associated with complications such as adult respiratory distress syndrome, renal failure, shock, and disseminated intravascular coagula tion. Organisms were cultured from the necrotic site in 3 cases. Two p atients died. DISCUSSIONS: Tissue necrosis is a rare but serious compl ication of intramuscular administration of medicines, including nonste roidal 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 spreadi ng infection with necrosis of fascia and subcutaneous fat. CONCLUSIONS : Intramuscular administration of diclofenac may be associated with se vere tissue necrosis or necrotizing fasciitis. Although rare, these se rious complications should be considered when intramuscular injection of NSAIDs is contemplated.