Cutaneous eruptions in coma patients with nontraumatic rhabdomyolysis

Rhabdomyolysis has been described most commonly after muscle injury but may also result from coma due to alcohol intake or drug abuse. Its clinical findings usually occur as muscular pain and swelling, but these symptoms are also seen in as many as 60% of patients with nontraumatic rhabdomyolysis. The diagnosis of slight nontraumatic rhabdomyolysis is often difficult to establish clinically. Few previous studies have reported cutaneous symptoms in nontraumatic rhabdomyolysis.

We attempted to elucidate a relationship between nontraumatic rhabdomyolysis and cutaneous eruption.

We studied 7 patients who were diagnosed as having massive to slight nontraumatic rhabdomyolysis with a cutaneous eruption in pressure areas at the first visit to our hospital between March 28, 1988, and June 27, 1998.

They revealed wine-red-colored urine and elevated serum myogenic enzyme. Two patients complained of muscle pain. In all patients, cutaneous eruptions including well-demarcated erythema, bullae and deep ulcers were observed in areas of pressure. The pathological findings of 5 cutaneous eruptions revealed necrosis of sweat ducts and glands in the dermis.

The pathogenesis of nontraumatic rhabdomyolysis and the cutaneous eruptions in coma patients has not been elucidated, but these conditions are due to similar factors; pressure and hypoxia are considered to be important causative factors for both. Cutaneous eruptions in the coma patient may be an important clinical symptom of nontraumatic rhabdomyolysis.