Cutaneous eruptions in coma patients with nontraumatic rhabdomyolysis

Background: Rhabdomyolysis has been described most commonly after muscle in jury but may also result from coma due to alcohol intake or drug abuse. Its clinical findings usually occur as muscular pain and swelling, but these s ymptoms are also seen in as many as 60% of patients with nontraumatic rhabd omyolysis. The diagnosis of slight nontraumatic rhabdomyolysis is often dif ficult to establish clinically. Few previous studies have reported cutaneou s symptoms in nontraumatic rhabdomyolysis. Objective: We attempted to eluci date a relationship between nontraumatic rhabdomyolysis and cutaneous erupt ion. Methods: We studied 7 patients who were diagnosed as having massive to slight nontraumatic rhabdomyolysis with a cutaneous eruption in pressure a reas at the first visit to our hospital between March 28, 1988, and June 27 , 1998. Results: They revealed wine-red-colored urine and elevated serum my ogenic enzyme. Two patients complained of muscle pain. In all patients, cut aneous eruptions including well-demarcated erythema, bullae and deep ulcers were observed in areas of pressure. The pathological findings of 5 cutaneo us eruptions revealed necrosis of sweat ducts and glands in the dermis. Con clusions: The pathogenesis of nontraumatic rhabdomyolysis and the cutaneous eruptions in coma patients has not been elucidated, but these conditions a re due to similar factors; pressure and hypoxia are considered to be import ant causative factors for both. Cutaneous eruptions in the coma patient may be an important clinical symptom of nontraumatic rhabdomyolysis. Copyright (C) 2001 S. Karger AG, Basel.