Bullae and Sweat Gland Necrosis in the Differential Diagnosis for Vibrio vulnificus Infection in an Alcoholic Patient

Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.

Bullae and Sweat Gland Necrosis in a Non-comatose Patient after Alcohol Intake / 대한피부과학회지

Bullae and sweat gland necrosis is an entity previously reported to occur in comatose patients. Since its first description in comatose patients after carbon monoxide intoxication, similar lesions have also been reported in comatose patients after overdose with several drugs and in immobilized non-comatose patients. To our knowledge, there have been only three occurrences of bullae and sweat gland necrosis after alcohol intake in the Korean dermatologic literature. These cases were never described, but only summarized in a table of an original article. Herein, we more fully describe a case of bullae and sweat gland necrosis in a non-comatose patient after alcohol intake. The case demonstrates conclusively that bullae and sweat gland necrosis can occur not only in a comatose patient but also in a non-comatose patient.

A Case of Bullae and Eccrine Sweat Gland Necrosis in a Patient with Drug-Induced Coma / 대한피부과학회지

Coma-induced bullae and sweat gland necrosis is a rare clinicopathologic entity often associated with alcohol intake or drug abuse (barbiturate and benzodiazepine overdose). Local pressure and hypoxia are considered to be important causative factors. But, the exact pathogenesis remains unknown. Herein, we report a case with clinical and histologic findings characteristic of blisters and sweat gland necrosis occurring in a drug-induced comatose patient.

Bullae and Sweat Gland Necrosis: Clinicopathologic Observations

Bullae and sweat gland necrosis have been often described in patients with mental ges, whieh commonly alanifested as erythematous or vesicobullaus lesions on pressure sites. Histopathologically, the aecrosis of sweat glands is a characteristic 6nding. Generalized and/or loca1 tlssue bypoxia due to prolonged ieamobihxation may have resulted in these clinical and histopakological manifestations. To date, we have experielwed 15 cases with bulla and sweat gland necrosis. On admission, about half the patients had carbon monoxide poisoning, and the remainders had alcohol overdosage, drug inioxication, and others. A11 our patients had menfal changes caused by carbon wonoxide poisening, aleohol intoxication, and others. Abrupt erythematous swelling and/or vesicobullous lesione affected pressure sites in all patients. Three patietns had erythematoias lesiqms on non-pressure sites simuhtaneously. Histopathologic examinatians of 12 biopsy specimes showed the necrosis of the epidermis, intra- or sub-epidermal bulla, and/or sweat gland necrosis.