Compartment syndrome of the calf due to Nicolau syndrome

We report a case of Nicolau syndrome in a 15 months old girl following an intramuscular injection of penicillin 6.3.3 in
her left buttock. This case is unique because she developed compartment syndrome in her left calf far from her injection
site. Her toe’s tips gangrened in the course of her ailment. We hypothesized that the compartment syndrome might
be produced by a probable intra-arterial injection that had produced embolic obstruction of the small and medium size
arteries in her leg or a probable perineural or periarteial injection had produced secondary sympathetic stimulation,
extensive vasospasm, compromised microcirculation and the development of compartment syndrome.