J Korean Med Sci.  2011 Mar;26(3):450-453. 10.3346/jkms.2011.26.3.450.

Bullae and Sweat Gland Necrosis in the Differential Diagnosis for Vibrio vulnificus Infection in an Alcoholic Patient

• Kim GW
• Park HJ
• Kim HS
• Kim SH
• Ko HC
• Kim MB
• Kim BS

• KMID: 2157887
• DOI: http://doi.org/10.3346/jkms.2011.26.3.450

Abstract

Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.

Keyword

Alcohol; Bullae and Sweat Gland Necrosis; Sweat Glands; Vibrio vulnificus infection

MeSH Terms

*Alcoholic Intoxication/etiology
Alcoholism/diagnosis
Blister/complications/*diagnosis
Cellulitis/diagnosis
Diagnosis, Differential
Fasciitis, Necrotizing/diagnosis
Humans
Male
Middle Aged
Necrosis/complications/diagnosis
Sweat Gland Diseases/complications/*diagnosis
Vibrio Infections/diagnosis

Figure

• 

  Fig. 1 Clinical photographs. Multiple broad-based tense bullae, healing erosions, and prominent edema are visible on the left arm compared with the right arm. Two erythematous plaques on the left upper arm and left chest that were mildly tender are seen.

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  Fig. 2 Histopathological findings from the left arm. (A) Focal epidermal necrosis with re-epithelialization and a mild perivascular lymphohistiocytic inflammatory cell infiltrate are seen on sections (H&E stain, ×40). (B) Extensive necrosis of the secretory cells of sweat glands and eosinophilic homogenization of the cytoplasm are seen on the sections (H&E stain, ×400).

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