Hemorrhagic bullae represent an ominous sign for cirrhotic patients

Hemorrhagic bullae are a clinical manifestation of many underlying diseases, especially soft-tissue infection. The aim of this study was to evaluate the characteristics and prognosis of cirrhotic patients with hemorrhagic bullae. Fifteen patients with liver cirrhosis and hemorrhagic bullae had been admitted to Chang Gung Memorial Hospital, Kaohsiung, from January to December 2003. Their clinical courses were retrospectively reviewed in detail and all of the collected data were analyzed. This study puts emphasis on the clinical presentation and outcome of these cases. The mean age of patients was 55.0 +/- 12.1 years, and 12 patients were male. Prostration and unusual extremity pain were the two leading reasons to visit our Emergency Department. The hemorrhagic bullae were located on the upper or lower extremities and in one patient, on the whole body. In this series all hemorrhagic bullae were infection-related. Although aggressive treatment was started immediately upon arrival, 14 patients died of overwhelming sepsis and 12 patients died within 48 h from the emergence of hemorrhagic bullae. Hemorrhagic bullae in cirrhotic patients usually imply a fatal infection and Gram-negative bacteria are the most common pathogen. Appropriate antimicrobial therapy and early surgical intervention are necessary to achieve survival in these patients.