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Hemorrhagic bullae are not only skin deep
Cheng-Ting Hsiao1, Leng-Jye Lin, Chi-Jei Shiao
1Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan.
The American Journal of Emergency Medicine
|March 25, 2008
Summary
Hemorrhagic bullae often indicate necrotizing fasciitis, particularly Vibrio infections. Early recognition in emergency departments is crucial for prompt, aggressive treatment to improve patient outcomes.
Area of Science:
- Emergency Medicine
- Infectious Disease
- Dermatology
Background:
- Dermatologic complaints, including hemorrhagic bullae, are frequent emergency department (ED) presentations.
- Hemorrhagic bullae can be early external signs of systemic or immune responses to infections, toxins, medications, or diseases.
- Patients with life-threatening skin lesions may appear well initially but can deteriorate rapidly.
Purpose of the Study:
- To prospectively analyze the clinical characteristics and diagnoses of patients presenting with hemorrhagic bullae to the ED.
- To identify the common etiologies and outcomes associated with hemorrhagic bullae.
Main Methods:
- Prospective, observational cohort study conducted at a university-affiliated community hospital.
- Data collected from January 2002 to January 2007.
- 42 patients presenting to the ED with hemorrhagic bullae were enrolled.
Main Results:
- Necrotizing fasciitis was the confirmed diagnosis in all 42 patients (100%).
- Vibrio species were the most common organisms identified in blood and wound cultures.
- Diabetes mellitus was the most frequent comorbidity (42.9%).
- 19% of patients died, with delayed presentation (after 48 hours) not correlating with mortality in this cohort.
Conclusions:
- Necrotizing fasciitis is the primary cause of hemorrhagic bullae in this study population.
- Hemorrhagic bullae are more indicative of Vibrio infection than streptococcal infection.
- Hemorrhagic bullae can be an early sign of necrotizing fasciitis, necessitating a high index of suspicion for Vibrio infection and aggressive treatment.
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