酒精引起昏迷而发生的大疱和汗腺坏死合并骨筋膜室综合症1例

A Case of Bullae and Sweat Gland Necrosis in Alcohol-Induced Coma with Osteofascial Compartment Syndrome

患者女,52岁。躯干及四肢散在分布水疱、大疱并伴有破溃、渗出和局部坏死1d。1d前患者饮酒后昏迷约3h时被发现左手背部出现散在分布的红斑、水疱,伴有疼痛;半小时后患者的左前臂及双侧手背出现大疱,躯干出现散在分布的红斑和水疱,以左前臂及左手为著。实验室检查:血WBC 17.1×109/L,NEUT%92.5%;生化:ALT 136U/L,AST 432U/L,CK 15 980U/L,CK-MB 221.2U/L,LDH 1 292U/L;心肌损伤标志物:MB 1 061.40ng/mL;凝血功能:PT 8.4s,FIB 4.28g/L,D-D 1 366ng/mL;DIC初筛:FDPs15.7mg/L。右前臂皮损组织病理示:表皮下水疱,汗腺周围可见嗜酸性粒细胞浸润。诊断:酒精致昏迷、大疱和汗腺坏死,左手和左前臂骨筋膜室综合症,右肺肺炎。予手术切除及对症治疗,已好转并出院。

A 52-year-old female presented with diffuse blisters, bullous, ulceration, exudation and local necrosis for l day. The patient was in a coma after drinking 1 day before and erythema,blister was found on the back of the left hand with pain after about three hours. The bulla was found on the left forearm and back of the both hands, scattered erythema and blisters on trunk after half an hour. The blood chemistry： WBC 17.1 x 10^9/ L, NEUT% 92.5%, ALT 136U/L, AST 432U/L, CK 15 980U/L, CK-MB 221.2U/L,LDH 1 292U/L, MB I 061.40ng/mL Blood coagulation： UF 8.4s, FIB 4.28g/L, D-D 1 366ng/mL. DIC early screening： FDPs 15.7mg/L. Pathological examination of the left forearm： Subepiderrnal blisters,filled with eosinophils around the sweat glands under the blisters. According to the medical history,clinical manifestation,the clini cal diagnosis of bullae and sweat gland necrosis in alocohol-indueed coma with osleofascial compartment syn- drome and pneumonia was made. The condition of the patient was improved and she discharged ＇after given st,rgery operation and some else treatment.