title: Coma blisters with hypoxemic respiratory failure.
abstract: A 24-year-old woman with quadriplegia was admitted with respiratory failure because of pneumonia. She was on multiple medications including diazepam, oxycodone, and amitriptyline, known to be associated with coma blisters, though she did not overdose on any of them. On hospital day 2, she developed multiple blisters on both sides of her right forearm and hand. Skin biopsy showed eccrine gland degeneration consistent with coma blisters. It was felt that hypoxemia from her pneumonia contributed to the development of these blisters, which occurred on both pressure and non-pressure bearing areas of the arm. Coma blisters are self-limited skin lesions that occur at sites of maximal pressure, mostly in the setting of drug overdose. However, coma blisters may occur with metabolic and neurological conditions resulting in coma.
authors.affiliation: Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Agarwal
authors.forename: Meghana
authors.initials: M
authors.lastname: Bansal
authors.forename: Kelly
authors.initials: K
authors.lastname: Conner
mesh_terms: D000639:Amitriptyline / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001768:Blister / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D003128:Coma / Q000150:complications*; D003975:Diazepam / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000078785:Mirtazapine; D010098:Oxycodone / Q000627:therapeutic use; D010100:Oxygen / Q000627:therapeutic use; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011014:Pneumonia / Q000150:complications; D011015:Pneumonia, Aspiration / Q000188:drug therapy; D011782:Quadriplegia / Q000188:drug therapy; D012131:Respiratory Insufficiency / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D000639:Amitriptyline; D008803:Mianserin; D010397:Penicillanic Acid; D000078785:Mirtazapine; D010098:Oxycodone; D003975:Diazepam; D010100:Oxygen; D010878:Piperacillin