Blister fluid composition in a pediatric patient with toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a rare life-threatening disease mostly related to drug ingestion. Apoptotic keratinocytes lead to separation of the epidermis from dermis and widespread blistering of the skin. This case is a pediatric patient with a seizure disorder who developed TEN after starting carbamezepine. Blister fluid was analyzed for protein, chemical, and mineral content. The TEN blister fluid composition was similar to burn blister, except that the burn blister fluid has a 3-fold increase in albumin and protein. There was a substantial increase in lactate dehydrogenase, calcium, and magnesium in both blister fluid specimens compared with serum levels. To our knowledge, this report is the first in the literature to analyze TEN blister fluid composition and compare it to burn blister fluid.

Hypercalcemia in patients in the burn intensive care unit.

Although patients with burns are known to develop hypocalcemia, the development of hypercalcemia has also been reported in a few patients in the burn intensive care unit. Here, the incidence of hypercalcemia in the burn unit of a single institution is reviewed. The records of all patients admitted to the burn intensive care unit over a period of 4 years of a single institution were reviewed. When looking at a select group of burn patients who have been hospitalized for more than 4 weeks, an unusually high incidence of hypercalcemia was found, especially in patients with renal failure (because of decreased renal clearance, patients with renal failure are prone to hypercalcemia if another inciting factor is present). As previously reported, the hypercalcemia in our patients was consistent with hypercalcemia caused by immobilization. We also observed that mortality correlated with higher calcium levels.

Chemical scalp burns after hair highlights.

Hair highlighting using chemical solutions to alter the pigmentation of hair is a popular procedure. Given their chemical properties, these solutions also are potentially caustic to the scalp. However, the actual incidence and range of injuries is not well reported in the American literature. We report a representative case from the severe end of the injury spectrum, that of a full-thickness chemical burn as a result of direct contact from hair-lightening solution. We review the composition and potential side effects of the chemicals used. Meticulous attention to the instructions of use is recommended to prevent these injuries. To our knowledge, this is the first case report of a full-thickness chemical scalp burn as a result of highlighting in the American literature, and we hope that it will serve as an educational resource with respect to the potential risks of this very common procedure.

Purpura fulminans in an adult patient with Haemophilus influenzae sepsis: case report and review of the literature.

Purpura fulminans is a rare complication of a coagulopathy or an infection. Haemophilus influenzae infection, which has decreased since the haemophilus influenzae type B vaccine was initiated, is an unusual initiating cause of purpura fulminans. This case is the first reported in the literature of an adult who developed purpura fulminans after Haemophilus influenzae sepsis. Her elevated beta2 glycoprotein 1 ratio may have contributed to the severity of her disease. Although rare, Haemophilus influenzae may precipitate purpura fulminans. Current therapy is directed at control of precipitating factors, removal of nonviable tissue, treatment of secondary infections, and physiologic support. There also is evidence that patients respond well to hyperbaric oxygen therapy, with decreasing limb and tissue loss.