title: Immunohistochemical investigation of the coma blister and its pathogenesis.
abstract: The erythematous patches and vesicles that are observed in coma patients, usually from an overdose of medication, are known as coma blisters. However, it is unknown whether the degenerated sweat gland is a necrosis or apoptosis. We immunohistochemically examined such skin lesions to investigate the characteristics and pathogenesis of the coma blister. Skin lesions were obtained from a forensic autopsy case, a woman in her thirties, of caffeine intoxication. Those lesions were observed in the left femoral, the lower left thigh, and the right knee. Histologically, the skin lesions showed that the keratinocytes had necrosed and the epidermis was thin in some areas. Eccrine sweat gland degeneration was observed. Obvious inflammatory cell infiltrations were not detected. Immunohistochemically, we stained each skin lesion against CD3, CD8, CD45RO, cytokeratin, 70 kD heat shock protein, ubiquitin, 150 kD oxygen regulated protein, and caspase-cleaved keratin 18 neo-epitope M30. They were also stained with an in situ apoptosis detection kit. Degenerated sweat glands featured CD45RO and M30 immunoreactivity. Immunohistochemical staining for CD45RO, CK-L, and M30 might be useful to observe sweat gland degeneration in the coma blister. Therefore, the apoptosis might be related to coma blisters and sweat gland degenerations.
authors.affiliation: Department of Forensic Medicine, Faculty of Medicine, Fukuoka University.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kashiwagi
authors.forename: Akiko
authors.initials: A
authors.lastname: Ishigami
authors.forename: Kenji
authors.initials: K
authors.lastname: Hara
authors.forename: Aya
authors.initials: A
authors.lastname: Matsusue
authors.forename: Brian
authors.initials: B
authors.lastname: Waters
authors.forename: Mio
authors.initials: M
authors.lastname: Takayama
authors.forename: Itsuo
authors.initials: I
authors.lastname: Tokunaga
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Nishimura
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Kubo
mesh_terms: D000328:Adult; D017209:Apoptosis; D001344:Autopsy; D015415:Biomarkers / Q000378:metabolism; D001768:Blister / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D003128:Coma / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D062787:Drug Overdose / Q000150:complications; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D012867:Skin / Q000473:pathology; D013545:Sweat Glands / Q000378:metabolism / Q000473:pathology
chemical_list: D015415:Biomarkers