Coma Blisters in the Setting of Quetiapine Overdose: Case Report and Review of Literature

Abstract

Background: Skin lesions and blistering in the overdose patient, most notably associated with barbiturate overdoses, are commonly referred to as coma blisters, ‘barb blisters’, or ‘barb burns’. We present a patient who was noted to have skin lesions including bullae and blistering following a prolonged coma after quetiapine overdose. Case report: A 27 year old male presented to our institution with the history of having ingested 7,200 mg of quetiapine in a suicide attempt up to 35 hours prior to being discovered. The patient was found comatose, and was noted to have multiple vesicles on his right ankle and a firm, erythematous plaque and bullae on his right thigh. Discussion: Sequelae related to prolonged immobility of any cause may include injury to muscle, vascular, microvascular and cutaneous structures. Coma blisters differ from pressure ulcers in many ways and cannot be graded using the typical staging system. Histopathologic analysis suggests an array of microvascular injuries which are secondary to direct pressure injury as well as specific drug effect. Conclusion: This is the first description of a dermatologic manifestation attributed to coma from isolated quetiapine overdose. Blister formation can be considered as a possible complication of quetiapine overdose.