To the Editor.—
In the article "Subepidermal Bullae Secondary to Escherichia coli Septicemia" by Fisher et al in the Archives (110:105, 1974), the authors fail to consider the possibility that the bullae that they observed were simply due to pressure. Pressure-induced cutaneous ischemia and anoxia not uncommonly result in the formation of bullae in moribund semiconscious patients.1,2 The authors' patient was described as "stuporous," and thus presumably remained relatively immobile for long periods of time, insensitive to the discomfort of uninterrupted pressure. The localization of her lesions to two sites of potential mutual apposition—the ventral surface of the arm and the chest— is consistent with a pressure-induced pathogenesis, as is the subepidermal location of the blisters.Interestingly, a similar case of a bullous eruption in a patient with a fatal Escherichia coli septicemia was reported by Plaut and Mirani.3 These authors were also able to culture E coli
Voron DA. Bullae Due to Pressure. Arch Dermatol. 1975;111(4):528. doi:10.1001/archderm.1975.01630160118025
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