Hypoxic brain damage after intramuscular self-injection of diclofenac for acute back pain

We present a case of hypoxic brain damage that occurred after intramuscular injection of diclofenac due to a severe anaphylactic reaction. A 38-year-o ld nurse treated herself for acute lower back pain with 100 mg diclofenac i ntramuscularly. Five minutes later, she collapsed and developed coma and re spiratory arrest. After cardiopulmonary resuscitation she was transferred t o hospital. On admission she was comatose and received controlled ventilati on of the lungs. Magnetic resonance imaging and computerized tomography sho wed signs of hypoxic brain injury and the patient died from central cardiop ulmonary failure 7 days later. Intramuscular treatment with non-steroidal a nti-inflammatory drugs such as diclofenac has rare but potentially severe s ide-effects. Therefore, intramuscular injections are inappropriate and shou ld tie replaced with oral or rectal treatment, which has similar absorption profiles.