![]() ![]() He was able to walk to the ambulance unassisted and was taken to the nearest emergency department. Upon arrival of the paramedics, he was alert and orientated and did not report a fall or loss of consciousness. The patient was able to walk out from the switchgear. There were signs of damage inside the bay unit with the earthing circuit connector indicating that earthing of electric current occurred at least partially, over a very short distance, when the patient's hand or the combination wrench initiated the electrical arc ( Figures 1A,B). Of note, he had a large metal combination wrench (for 19 mm nuts) in his right front hip pocket that may have influenced the injury pattern. He directed his hand towards one of the 20 kV outgoing units and was “struck” by electricity from electrical arcing ( Figure 1A). He was examining the connexions within the switchgear and incorrectly assumed the “bay unit” to be de-energised. Case PresentationĪ 47-year-old otherwise healthy electrician sustained a high voltage electrical burn whilst at work commissioned to extend a 20 kV outgoing bay unit in an air-insulated high-voltage switchgear. We performed untargeted non-labelled proteomics and immunohistochemistry on paraffin-embedded biopsy sections of LF-affected skin in comparison to follow-up skin samples to unravel the molecular and histological pathobiology of the tissue response at the time of LFs. Here, we describe the protein-level molecular characterisation of LFs in a patient that suffered a high-voltage electrical injury from an alternating current switchgear and presented with non-blanching red marks consistent with LFs over his right flank. Our group recently reported a case of LFs following a lightning strike injury and discussed its possible pathophysiology ( 10, 12). They arise from a positive discharge on the skin that, in the case of negatively charged lightning, is speculated to be generated by flashover from a nearby protrusion at earth potential ( 11). LFs appear to be a mysterious infrequent, transient sequelae of lightning strike injuries and have been sporadically reported in several case reports ( 1– 10). The true pathophysiology of LFs remains unknown ( 2, 3). ![]() They received their name from Georg Lichtenberg, who in 1777 first described them whilst conducting static electricity experiments. Lichtenberg figures (LFs), also known as ferning pattern, feathering, keraunographic markings or arborescent burns, are a pathognomonic skin sign for a lightning strike injury ( 1). Our results provide an initial molecular and cellular insight into the tissue response associated with LFs. ![]() These changes in the LF-affected skin were associated with extravasation of red blood cells from dermal vessels. Our results demonstrated an increase in dermal T-cells and greatly increased expression of the iron-binding glycoprotein lactoferrin by keratinocytes and lymphocytes. The aim was to characterise the tissue response of LFs by performing untargeted non-labelled proteomics and immunohistochemistry on paraffin-embedded sections of skin biopsies taken from the area of LFs at presentation and at 3 months follow-up. Their true pathophysiology has remained a mystery and only once before described following an electical injury. LFs, also known as ferning pattern or keraunographic markings, are a pathognomonic skin sign for lightning strike injuries. We describe a case of Lichtenberg Figures (LFs) following an electrical injury from a high-voltage switchgear in a 47 year-old electrician.
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