Coma blisters after poisoning caused by central nervous system depressants: case report including histopathological findings.

Abstract

Blister formation and eccrine sweat gland necrosis is a cutaneous manifestation associated with states of impaired consciousness, most frequently reported after overdoses of central nervous system depressants, particularly phenobarbital. The case of a 45-year-old woman who developed "coma blisters" at six distinct anatomic sites after confirmed (laboratory) phenobarbital poisoning, associated with other central nervous system depressants (clonazepam, promethazine, oxcarbazepine and quetiapine), is presented. A biopsy from the left thumb blister taken on day 4 revealed focal necrosis of the epidermis and necrosis of sweat gland epithelial cells; direct immunofluorescence was strongly positive for IgG in superficial blood vessel walls but negative for IgM, IgA, C3 and C1q. The patient was discharged on day 21 with no sequelae.

• Authors: Maira Migliari Branco, Eduardo Mello De Capitani, Maria Letícia Cintra, Stephen Hyslop, Adriana Camargo Carvalho, Fabio Bucaretchi
• Journal: Anais brasileiros de dermatologia (An Bras Dermatol) 2012 Jul-Aug Vol. 87 Issue 4 Pg. 615-7 ISSN: 1806-4841 [Electronic] Spain
• PMID: 22892778 (Publication Type: Case Reports, Journal Article)

Chemical References

• Central Nervous System Depressants

Topics

• Blister (chemically induced, pathology)
• Central Nervous System Depressants (poisoning)
• Coma (chemically induced, pathology)
• Epidermis (drug effects, pathology)
• Female
• Humans
• Middle Aged
• Necrosis (chemically induced, pathology)
• Sweat Glands (drug effects, pathology)