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

Maira Migliari Branco, Eduardo Mello De Capitani, Maria Letícia Cintra, Stephen Hyslop, Adriana Camargo Carvalho, Fabio Bucaretchi

Campinas Poison Control Center, Medical Science School, State University of Campinas, SP, Brazil. mairinha_branco@hotmail.com

Anais brasileiros de dermatologia 2012 Jul-Aug

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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.

Citation

Maira Migliari Branco, Eduardo Mello De Capitani, Maria Letícia Cintra, Stephen Hyslop, Adriana Camargo Carvalho, Fabio Bucaretchi. Coma blisters after poisoning caused by central nervous system depressants: case report including histopathological findings. Anais brasileiros de dermatologia. 2012 Jul-Aug;87(4):615-7