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

A 63-year-old man was found in the street after overrun by a car. Postmortem CT revealed multiple bone fractures, but surprisingly all without any relevant hemorrhage which would have been expected under such circumstances. A round radiopaque formation was found in the duodenum, which was reminiscent of ingested tablets. The toxicological analysis revealed high concentrations of zopiclone and alcohol. By combining radiologic and forensic results, zopiclone and alcohol intoxication were concluded as the cause of death, followed by a postmortem overrun accident.
Accidents, Traffic ; Alcoholic Intoxication/*diagnosis ; Azabicyclo Compounds/analysis/*poisoning ; Duodenum/*radiography ; Fatal Outcome ; Humans ; Hypnotics and Sedatives/analysis/*poisoning ; Male ; Middle Aged ; Piperazines/analysis/*poisoning ; Tomography, X-Ray Computed/*methods