Gauthier Amélie,1,2 Mankouri Farid,1 Berbain Thomas,1 Burlet Gilles,3 Bourrain Jean Luc,1 Demoly Pascal,1,4 Chiriac Anca Mirela1,4

1 Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Univ Montpellier, France
2 Department of Allergy and Immunology, Laval University Hospital Center, Laval University, Quebec City, Canada
3 Department of Gynecology and Obstetrics, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Univ Montpellier, France
4 Institut Desbrest d’Epidémiologie et de Santé Publique UMR INSERM – Université de Montpellier

Abstract

Background: Local anesthetics (LA) are widely used in medicine and are generally well tolerated. Although most adverse reactions are nonallergic, LA are a frequent reason for allergy consultation.
Objective: We want to expand the differential diagnosis of adverse reactions to LA by presenting rare diagnoses.
Methods: We present here two patients with similar clinical presentations, namely skin necrosis after local anesthesia with lidocaine, but with two different final diagnoses.
Results: For Patient 1, skin necrosis was imputed to the vasoconstrictor effect of epinephrine in a patient with vascular background aggravated by heavy consumption of tobacco and cannabis. Patient 2 final diagnosis was Nicolau syndrome (embolia cutis medicamentosa), a cutaneous necrosis at the site of injection.
Conclusion: The allergist should be aware of these diagnoses and include them in the differential diagnosis of local anesthetic hypersensitivity.
Key words: drug hypersensitivity, drug allergy evaluation, local anesthetics, skin necrosis, local anesthetic hypersensitivity