Nicolau Syndrome After Glatiramer Acetate Injection in Close Proximity to Administration of SARS-CoV-2 mRNA Vaccine.

Nicolau syndrome (synonym: embolia cutis medicamentosa) is a rare complication of subcutaneous and IM drug injections, typically independent of the drug itself. Patients develop painful purpuric and necrotizing lesions at the injection site, often requiring surgical intervention. The pathogenesis of the ischemic skin necrosis is poorly understood. We report 2 cases of skin necrosis associated with injection of glatiramer acetate (GA) in patients with multiple sclerosis (MS), which occurred in close temporal relation to the second dose of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) mRNA vaccine.