ABSTRACT
BACKGROUND: Flagellate dermatitis caused by the intake of shiitake mushrooms is characterized by linear erythematous lesions that are intensely pruritic. It is common in countries where the consumption of mushrooms is high, but it is rare in Latin America. It can be difficult to diagnose as there is a delay between the intake of the mushroom and the eruption. CASE REPORT: A 49-year-old Caucasian woman with a history of hypothyroidism who, 48 hours after the intake of shiitake mushrooms, developed intense itching associated with the appearance of linear and erythematous lesions, in a "flagellate-like" pattern, predominantly on the trunk, without other signs or symptoms. There was no history of recent exposure to drugs. She was treated with oral antihistamine and topical corticosteroid, however, without improvement, which is why a short cycle of oral corticosteroid was required, with which her lesions were resolved. A shiitake-free diet was indicated. CONCLUSIONS: Flagellate dermatitis is a toxicoderma that is associated with the intake of shiitake mushrooms among other things. Its clinical presentation is characteristic, although its exact pathophysiology is not fully understood. The boom of Asian food in Latin America might lead to an increase in the number of cases; hence the importance of knowing about its existence.
Antecedentes: La dermatitis flagelada por setas shiitake se caracteriza por lesiones eritematosas lineales muy pruriginosas. Es común en países con alto consumo de hongos, pero poco frecuente en Latinoamérica. Puede ser difícil de diagnosticar debido al retraso en la aparición de las erupciones después de la ingesta del hongo. Caso clínico: Mujer caucásica de 49 años, con antecedente de hipotiroidismo, quien 48 horas después de la ingesta de setas shiitake desarrolló prurito intenso asociado a lesiones lineales, eritematosas, con patrón de flagelación, predominantes en tronco, sin otros signos ni síntomas. No había historia de exposición reciente a medicamentos. Recibió antihistamínico oral y corticoide tópico sin mejoría, por lo que requirió ciclo corto de corticoide oral, con el cual se resolvieron las lesiones. Se le indicó evitar el consumo del hongo en la dieta. Conclusiones: La dermatitis flagelada constituye una toxicodermia asociada, entre otras cosas, al consumo de setas shiitake. Su presentación clínica es característica, aunque su fisiopatología no está completamente entendida. El auge de la comida oriental en Latinoamérica podría incrementar el número de casos, de ahí la importancia de conocer esta toxicodermia.
Subject(s)
Dermatitis/immunology , Food Hypersensitivity/complications , Shiitake Mushrooms , Dermatitis/pathology , Female , Humans , Middle AgedABSTRACT
El eritema flagelado es una erupción cutánea poco frecuente con múltiples causas, dentro de las cuales se encuentra la ingesta de hongos shiitake crudos o semicrudos. Se postula que es secundario a una reacción de hipersensibilidad Th-1 producida por el lentinan, un polisacárido termolábil de la pared celular del hongo. En años recientes ha aumentado su incidencia en el mundo occidental debido a la creciente popularidad de la comida asiática, en la que los hongos shiitake son un ingrediente muy utilizado. El cuadro clínico se caracteriza por la aparición de lesiones eritematosas lineales pruriginosas principalmente en tronco y extremidades, de curso autolimitado. El diagnóstico es principalmente clínico, basado en el antecedente de ingesta reciente de hongos shiitake y el rash característico y el tratamiento es sintomático con antihistamínicos y corticoides tópicos u orales. A continuación, presentamos un caso de eritema flagelado en una mujer joven, secundario a ingesta de hongos shiitake, que se resolvió completamente en 2 semanas.
Flagellate erythema is a rare skin eruption with many causes, including the ingestion of raw or undercooked shiitake mushrooms. It is thought to be a Th-1 hypersensitivity reaction produced by lentinan, a thermolabile polysaccharide found in the cell wall of the mushroom. In recent years, there has been an increase in the number of cases due to the growing popularity of Asian cuisine, in which shiitake mushrooms are a central ingredient. The clinical presentation is characterized by the appearance of linear, erythematous, pruritic lesions mostly on the trunk and extremities, of self-limited course. Diagnosis is mainly clinical, based on the history of recent shiitake mushroom ingestion and the characteristic rash, and treatment is symptomatic, with antihistamines and topical or systemic steroids. In this report, we present a case of flagellate erythema in a young woman, that appeared after the ingestion of shiitake mushrooms, and resolved completely after 2 weeks.
Subject(s)
Humans , Female , Adult , Mushroom Poisoning/diagnosis , Mushroom Poisoning/etiology , Shiitake Mushrooms , Erythema/diagnosis , Erythema/etiology , Mushroom Poisoning/drug therapy , Erythema/drug therapy , Histamine Antagonists/therapeutic useABSTRACT
Shiitake Dermatitis is often presented as papules and erythemato-violaceous linear streaks. It can be associated with bleomycin treatment, dermatomyositis and shiitake mushroom (Lentinus edodes). There is not any previous report concerning this rare etiology in our country. Shiitake is the second most consumed mushroom worldwide and it can cause flagellate erythema when ingested raw or half cooked. It has a higher incidence in Oriental countries because of their eating habits, this is the first case reported in Brazil, in a male patient that presented a cutaneous rash after consuming this raw mushroom.
A dermatite flagelada é caracterizada por pápulas eritematosas lineares com aspecto de "chicotada". A etiologia pode ser associada ao uso de bleomicina, dermatomiosite e shiitake (Lentinus edodes). Este é o segundo cogumelo mais consumido no mundo e pode ser causa de dermatite flagelada quando ingerido cru ou mal cozido. Não há relatos nas literaturas de quadro de dermatite flagelada por shiitake em nosso país, reportamos o primeiro caso no Brasil de um paciente masculino que desenvolveu o quadro após a ingesta desse cogumelo cru.
Subject(s)
Adult , Humans , Male , Dermatitis/etiology , Erythema/etiology , Mushroom Poisoning/complications , Shiitake Mushrooms , Brazil , Dermatitis/pathology , Erythema/pathologyABSTRACT
Shiitake (Lentinus edodes) is the second most consumed mushroom in the world. It has long been known in Asian medicine for its anticarcinogenic, antihypertensive and serum cholesterol level reduction properties. Nevertheless, the consumption of raw or not well-cooked mushrooms may cause skin eruptions which usually occur 24 to 48 hours after ingestion and are characterized by linearly arranged pruritic erythematous papules and plaques. We present a 36-year-old patient that developed typical symptoms 24 hours after consumption of shiitake mushrooms and summarize therapeutic options and particularities of this disease.
Shiitake (Lentinus edodes) é o segundo tipo de cogumelo mais consumido no mundo. Suas propriedades terapêuticas antitumorais, anti-hipertensivas e redutoras dos níveis elevados de colesterol são há muito conhecidas pela população asiática. Após ingestão desse cogumelo, cru ou malcozido, podem desenvolver-se lesões eritematosas lineares, pruriginosas, que surgem após 24 ou 48 horas em todo o corpo. Apresentamos um paciente de 36 anos com anamnese e clínica típicos, e comentamos as alternativas terapêuticas e nuances dessa dermatose.