Journal Information
Vol. 99. Issue 1.
Pages 65-66 (1 July 2023)
Vol. 99. Issue 1.
Pages 65-66 (1 July 2023)
Images in Paediatrics
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Coma blisters on a patient with respiratory failure
Ampollas del coma en paciente con insuficiencia respiratoria
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Virginia Courel del Ríoa,
Corresponding author
vcourelr@gmail.com

Corresponding author.
, María Fernández Miajaa, Borja Gómez Vilab, Laura Palacios Garcíab
a Unidad de Hospitalización y Urgencias de Pediatría, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Asturias, Spain
b Servicio de Dermatología, Hospital Universitario Central de Asturias, Asturias, Spain
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We present the case of a girl aged 8 years with cerebral palsy in treatment with valproic acid. She was admitted due to a respiratory tract infection with hypoxaemia, at which time she presented with hyperglycaemia (blood glucose, 160−190 mg/dL), and was treated with amoxicillin-clavulanic acid and oxygen therapy. At 72 h she exhibited distal oedema and decreased perfusion with cyanosis in the left forearm and right foot, areas in which a catheter had become accidentally dislodged earlier on. A few hours later, she had developed taut blisters in both locations, first filled with clear fluid (Fig. 1), and later with blood-stained fluid (Fig. 2), without signs of inflammation or injury in any other location. We made a suspected diagnosis of coma blisters, given the presentation and general condition of the patient, considering hypoxaemia, metabolic changes, limited mobility and treatment with valproic acid potential triggering factors. The lesions resolved within 3 weeks with antiseptic measures, a topical antibiotic and correction of the triggering factors. Coma blisters are a benign and self-limiting disease that requires ruling out other blistering diseases. Few cases have been described in children.1 The pathogenesis is multifactorial, including ischaemia secondary to prolonged local pressure, hypoxaemia or drug toxicity.2 The clinical manifestations suffice to make the diagnosis, and a histological examination may be needed in uncertain cases.3

Figure 1.

Blisters filled with clear fluid in the back of the hand and fingers.

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Figure 2.

Progression to blisters filled with blood-stained fluid.

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Funding

This research did not receive any external funding.

Conflicts of interest

The authors have no conflicts of interest to declare.

References
[1]
L. Bosco, D. Schena, C. Colato, P. Biban, G. Girolomoni.
Coma blisters in children: case report and review of the literature.
J Child Neurol., 28 (2013), pp. 1677-1680
[2]
A.H. Chacon, U. Farooq, S. Choudhary, N. Yin, B. Nolan, M. Shiman, et al.
Coma blisters in two postoperative patients.
Am J Dermatopathol., 35 (2013), pp. 381-384
[3]
I. Torres-Navarro, C. Pujol-Marco, J. Roca-Ginés, R. Botella-Estrada.
Coma blisters. A key to neurological diagnosis.
Neurologia (Engl Ed), 35 (2020), pp. 512-513
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