An 11-year-old girl, suffering from Dengue fever, developed pain and swelling in the dorsum of left hand following intravenous Ceftriaxone. The swelling resolved over 8 days and the affected area turned reddish violet and eventually black over next 20 days. On cutaneous examination, a single necrotic eschar 5×7 cm with a surrounding tough, fibrotic margin was present on the dorsum of the left hand (Fig. 1). On the basis of history and clinical features, we diagnosed Nicolau’s Syndrome. Debridement of the area of necrosis was done along with oral antibiotics. Her wound healed in three weeks (Fig. 2).

Fig. 1 Necrotic eschar on dorsum of left hand.	Fig. 2 Healed lesions after 3 weeks.

Nicolau’s Syndrome – also known as Embolia Cutis Medicamentosa – is a rare, cutaneous, adverse complication of drug administration. Inflammation, embolism, thrombosis and vasospasm are the various mechanisms proposed. Direct or indirect vessel damage involving any or all these mechanisms ultimately leads to peripheral arterial occlusion. Differentials to be considered are acute compartment syndrome (severe pain, pallor, swelling, paresthesia and poikilothermia), subcutaneous fat necrosis (seen exclusively in newborns), and gangrene (distally located). Prevention is by taking care to avoid accidental intra-arterial or para-arterial injection or injection of the drug into an arteriole. Debridement is the mainstay of therapy.