title: Phenobarbital-induced bullous lesions in a non-comatose patient.
abstract: The occurrence of dermatologic bullous lesions is well documented after barbiturate-induced intoxication. However, this rare clinicopathological entity is only reported in the setting of a coma or lethal toxicity. This case report presents a case of a noncomatose, nonimmobilized patient who developed systemic bullous lesions after an acute ingestion of oral phenobarbital. This case illustrates that bullous lesions can occur as a result of nontoxic phenobarbital doses, in the setting of subtherapeutic barbiturate blood levels. All previous case reports suggest phenobarbital produces either systemic bullae only after coma-inducing doses or a localized bullous reaction after a high-dose intravenous injection. This case challenges this previously held association. Although the exact mechanism of the bullous lesions remains unknown, the clinical course of the lesions is self-limiting and does not require additional care beyond the treatment of a superficial burn. Resolution of the bullae occured within two weeks. Since phenobarbital continues to be prescribed orally, physicians should recognize bullous lesions as a potential adverse dermatological reaction from non-lethal oral doses of phenobarbital.
authors.affiliation: Mr. Keng is from Michigan State University, College of Human Medicine, East Lansing, Michigan; Drs. Lagos, Liepman, and Trever are from Michigan State University, Kalamazoo Center for Medical Studies, Department of Psychiatry, Kalamazoo, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Keng
authors.forename: Maritza
authors.initials: M
authors.lastname: Lagos
authors.forename: Michael R
authors.initials: MR
authors.lastname: Liepman
authors.forename: Kimberly
authors.initials: K
authors.lastname: Trever