Kashiwagi Masayuki, Ishigami Akiko, Hara Kenji, Matsusue Aya, Waters Brian, Takayama Mio, Tokunaga Itsuo, Nishimura Akiyoshi, Kubo Shin-ichi
Department of Forensic Medicine, Faculty of Medicine, Fukuoka University.
J Med Invest. 2013;60(3-4):256-61. doi: 10.2152/jmi.60.256.
The erythematous patches and vesicles that are observed in coma patients, usually from an overdose of medication, are known as coma blisters. However, it is unknown whether the degenerated sweat gland is a necrosis or apoptosis. We immunohistochemically examined such skin lesions to investigate the characteristics and pathogenesis of the coma blister. Skin lesions were obtained from a forensic autopsy case, a woman in her thirties, of caffeine intoxication. Those lesions were observed in the left femoral, the lower left thigh, and the right knee. Histologically, the skin lesions showed that the keratinocytes had necrosed and the epidermis was thin in some areas. Eccrine sweat gland degeneration was observed. Obvious inflammatory cell infiltrations were not detected. Immunohistochemically, we stained each skin lesion against CD3, CD8, CD45RO, cytokeratin, 70 kD heat shock protein, ubiquitin, 150 kD oxygen regulated protein, and caspase-cleaved keratin 18 neo-epitope M30. They were also stained with an in situ apoptosis detection kit. Degenerated sweat glands featured CD45RO and M30 immunoreactivity. Immunohistochemical staining for CD45RO, CK-L, and M30 might be useful to observe sweat gland degeneration in the coma blister. Therefore, the apoptosis might be related to coma blisters and sweat gland degenerations.
在昏迷患者中观察到的红斑和水疱，通常源于药物过量，被称为昏迷水疱。然而，尚不清楚退化的汗腺是坏死还是凋亡。我们通过免疫组织化学方法检查此类皮肤病变，以研究昏迷水疱的特征和发病机制。皮肤病变取自一例法医尸检病例，一名三十多岁因咖啡因中毒死亡的女性。这些病变见于左大腿、左大腿下部和右膝。组织学上，皮肤病变显示角质形成细胞坏死，部分区域表皮变薄。观察到小汗腺退化。未检测到明显的炎性细胞浸润。免疫组织化学方面，我们针对CD3、CD8、CD45RO、细胞角蛋白、70kD热休克蛋白、泛素、150kD氧调节蛋白和半胱天冬酶切割的角蛋白18新表位M30对每个皮肤病变进行染色。它们还用原位凋亡检测试剂盒进行染色。退化的汗腺具有CD45RO和M30免疫反应性。对CD45RO、CK-L和M30进行免疫组织化学染色可能有助于观察昏迷水疱中的汗腺退化。因此，凋亡可能与昏迷水疱和汗腺退化有关。
