Images in Paediatrics
Coma blisters on a patient with respiratory failure
Ampollas del coma en paciente con insuficiencia respiratoria
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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 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and later with blood-stained fluid (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), 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.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The pathogenesis is multifactorial, including ischaemia secondary to prolonged local pressure, hypoxaemia or drug toxicity.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The clinical manifestations suffice to make the diagnosis, and a histological examination may be needed in uncertain cases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0010" class="elsevierStylePara elsevierViewall">This research did not receive any external funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-06-16" "fechaAceptado" => "2022-10-28" "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1150 "Ancho" => 1005 "Tamanyo" => 77244 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blisters filled with clear fluid in the back of the hand and fingers.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1785 "Ancho" => 1340 "Tamanyo" => 368708 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Progression to blisters filled with blood-stained fluid.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters in children: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Bosco" 1 => "D. Schena" 2 => "C. Colato" 3 => "P. Biban" 4 => "G. Girolomoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0883073812464684" "Revista" => array:6 [ "tituloSerie" => "J Child Neurol." "fecha" => "2013" "volumen" => "28" "numero" => "12" "paginaInicial" => "1677" "paginaFinal" => "1680" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters in two postoperative patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.H. Chacon" 1 => "U. Farooq" 2 => "S. Choudhary" 3 => "N. Yin" 4 => "B. Nolan" 5 => "M. Shiman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e31827955e7" "Revista" => array:7 [ "tituloSerie" => "Am J Dermatopathol." "fecha" => "2013" "volumen" => "35" "numero" => "3" "paginaInicial" => "381" "paginaFinal" => "384" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23334516" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma blisters. A key to neurological diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Torres-Navarro" 1 => "C. Pujol-Marco" 2 => "J. Roca-Ginés" 3 => "R. Botella-Estrada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nrl.2018.11.005" "Revista" => array:7 [ "tituloSerie" => "Neurologia (Engl Ed)" "fecha" => "2020" "volumen" => "35" "numero" => "7" "paginaInicial" => "512" "paginaFinal" => "513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30857784" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009900000001/v1_202307031305/S2341287923001229/v1_202307031305/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009900000001/v1_202307031305/S2341287923001229/v1_202307031305/en/main.pdf?idApp=UINPBA00005H&text.app=https://www.analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923001229?idApp=UINPBA00005H" ]
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