Unexplained Coma with Linear Skin Papules: A Diagnostic Trap Lest We Forget! A Case Report

Dermatoneuro syndrome presents with a sudden onset of coma of unknown origin, often in the setting of mucinosis. The linear array of skin-coloured papules is often the only clue to the diagnosis, and unless promptly, intravenous immunoglobulin at the dose of 2 g/kg divided over 5 days is started, most patients have a grim prognosis. The importance of recognition of this entity lies in the differential diagnosis of coma of unknown origin. Often, dermatologists are called after a significant number of days have lapsed since the patients have entered into coma, resulting in significant mortality. Sadly, all imaging studies and toxic screen/metabolic screen/autoantibody screen are normal. Herein, we report an unusual case of dermatoneuro syndrome secondary to scleromyxedema which went undiagnosed for a long duration owing to a lack of awareness of this entity amongst other specialities (such as neurology, where patients usually first present with coma).