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Eschar Formation Following Coma Bullae: A Case Report.

Divya Minnaganti¹, Arjun R Gampala¹, Yash P Khanna¹

¹Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA.

|May 21, 2024

Summary

Coma blisters (coma bullae) are skin lesions linked to drug-induced comas. This case highlights atypical presentations and vasculitic features, emphasizing complex wound care challenges.

Keywords:

blistering skin disease coma bullae eschar substance use wound care

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Area of Science:

Dermatology
Toxicology
Wound Care

Background:

Coma blisters (coma bullae) are skin lesions associated with impaired consciousness, often linked to central nervous system (CNS) depressants like opiates.
These lesions are thought to arise from skin pressure, leading to hypoxia and sweat gland damage, potentially exacerbated by drug properties.

Observation:

A 68-year-old male presented with unresponsive status and multiple bullae on the scalp, thighs, shoulder, and knuckles.
Urine drug screen was positive for cocaine and fentanyl; bullae expanded over two days, with some showing violaceous discoloration suggestive of vasculitis.

Findings:

The patient was diagnosed with coma bullae, with atypical distribution and suspected vasculitic features attributed to combined opiate and cocaine use.
While most bullae healed, eschars developed on the scalp and lower extremity, requiring surgical debridement.

Implications:

This case presents a unique manifestation of coma bullae, differing from typical pressure-related, self-limiting lesions.
Atypical blister sites, vasculitic features, and eschar development suggest complex multifactorial causes including drug use and social determinants of health.
Highlights challenges in managing coma bullae, particularly when atypical features and complications like eschars arise.