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.
*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

Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.
Adult ; Alcoholic Intoxication/*complications ; Ascorbic Acid/blood/therapeutic use ; Ascorbic Acid Deficiency/*complications/drug therapy/epidemiology ; Emergency Service, Hospital ; Female ; *Homeless Persons ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Vitamin B Complex/blood