Wednesday, August 27, 2008

One More Unfortunate...

Gina Kaulukukui is a grief counselor on the island of Kauai, Hawaii. She sent me the following text along with these photographs. Your impressions may help to solve this tragic mystery.

“I would like you to review the attached photos and give me your impressions. This 21 y.o woman was found in the water at Tunnels Beach on the north shore of Kauai following a night of partying. She was reportedly in the water about 7-15 minutes when she was pulled out unresponsive. When she was brought to the ER (at least a ½ drive) it was believed that she nearly drowned. She was unresponsive and not expected to survive.

While in the ER she presented on her thighs with unusual markings. The first appeared red jagged rings starting from her bikini line to just above the knee on one side and more toward the inner thigh on the other leg. Both were oval and completely blanched in the middle. There was a slight bruised color line in the center of one of the blanched areas. There were no others marks, lesions, etc.

The next day, the blanching went away and the red ring doubled in size from about 1 inch to about 2 inches. It was very red, raised and angry looking.

Later in the day when I went to check the young lady and convinced the ICU to photograph the area as it was again changing. Where the bruising was, small water blisters began to appear on the one leg, while the markings on the other leg was beginning to disappear. When the doctor was called to look at the blistering, she diagnosed it as a thermal burns.

The attached pictures were taken few hours following her death and as you can see on one side there is no marking left (the red mark on the upper thigh is from her blood pooling and not the original location of the blanching). The other side speaks for it self.

There were never any marks or puncture wounds that would indicate a jelly fish sting. The water was calm that day. She had high levels of cocaine and alcohol in her system. I would love to know what you think. We have yet to receive the biopsy results. I appreciate your and aloha Gina


  1. ..If she were a kid i would think "Scalded Skin Syndrome"... but it also could be abuse...especially if there were drugs and alcohol in her system. Mahalo for sharing. Aloha

  2. The linear arrangement of what appears to be tense blisters would suggest to me the possibility of phytophotodermatitis (eg, lime juice for cocktails). How sad an outcome!

  3. I was also struck by the linear nature of the lesions - parallel to the leg in the bullae, and circumferential on the thigh. Reminds me of the Holmes story, "the Lion's Mane" - can jellyfish be thoroughly ruled out?

  4. Caitlin StiglmeierAugust 28, 2008

    I got the link for the drowning on Kauai- tragic. I also think it looks VERY similar to the photodermatitis I had on my arm from mokihana... obviously NOT from mokihana, but similar-looking reaction. Interesting. (see my posting on VGRD blog from August 2007) CS, Medical Student, St. Georges University

  5. Sorry for this sad end.Regarding the diagnosis,I think it is photophytodermatitis although there are many sea animals and fish can cause poisoning and skin reaction.Biopsy should be helpfull
    khalifa sharquie

  6. sorry for her death,the major cause of linear bullous lesion is poison ivy(toxidendon dermatitis)plant that commonly found in eastren US and if taken orally produce what is called Baboon syndrome.
    Firas Altamimi

  7. Good Morning, sorry for the fatal outcome. I am an M.A. in Dermatology and would like to know if the bx report is back yet. Thanks

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