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S. Karger AG, Basel, Switzerland full text link S. Karger AG, Basel, Switzerland Free PMC article
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.2009 Oct 27;1(1):66-70.
doi: 10.1159/000249150.

Coma Blisters

Affiliations

Coma Blisters

Joana Rocha et al. Case Rep Dermatol..

Abstract

Coma blisters are lesions that occur in the setting of a variety of neurological diseases. Although most commonly associated with barbiturate overdose, they can be seen in the setting of coma due to other etiologies. Blisters develop 48-72 h after the onset of unconsciousness. We report the case of a 29-year-old man who presented to the emergency department with confusion and progressive loss of consciousness. He had high serum glucose, abnormal hepatic and kidney function tests and a normal toxicological screening. 24 h after admission he was comatose and was started on antibiotics for presumed bacterial meningoencephalitis. Two days after the onset of coma, multiple tense hemorrhagic blisters appeared on the patient's extremities. Skin biopsy revealed an intraepidermal blister with variable degrees of epidermal necrosis. Five days later the patient was fully recovered with no neurological sequelae. No topical treatment was necessary, with complete resolution of the skin lesions two weeks later.

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Figures

Fig. 1
Fig. 1
Tense hemorrhagic blisters on the patient's fingers and toes.
Fig. 2
Fig. 2
Intraepidermal blister and necrotic epidermis with mild inflammatory infiltrate. Hematoxylin & eosin, ×40.
Fig. 3
Fig. 3
Thrombosis of the vessels in the lower dermis with occlusion of the lumen by fibrinoid eosinophilic thrombi and red cell extravasation into the surrounding dermis. Hematoxylin & eosin, ×400.
See this image and copyright information in PMC

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