Case for Diagnosis
Pregnant Woman With Flagellate Erythema
Gestante con erupción flagelada
M. López-Núñez
, A. Jaka-Moreno, A. Tuneu-Valls
Corresponding author
Sección de Dermatología, Hospital Donostia, San Sebastián, Spain
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López-Núñez, A. Jaka-Moreno, A. Tuneu-Valls" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "López-Núñez" "email" => array:1 [ 0 => "marialopez1980@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Jaka-Moreno" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Tuneu-Valls" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Sección de Dermatología, Hospital Donostia, San Sebastián, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Gestante con erupción flagelada" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 667 "Ancho" => 1002 "Tamanyo" => 53075 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 36-year-old woman who was 39 weeks pregnant. She was referred by the gynecology unit for treatment of a pruritic eruption that had appeared 3 days earlier. The patient had no relevant past history and was not taking any regular medication. Her pregnancy was progressing normally. She was in the habit of taking walks in a rural area, always with her trunk covered. She had eaten at an Asian restaurant with her partner, who had no skin lesions, 2 days prior to the onset of symptoms.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple linear, erythematous, pseudovesicular plaques (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) on the patient's trunk, limbs, and face (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). The lesions were not evanescent or scaly, and they spared the periumbilical region. No abdominal striae were visible.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Because of our initial clinical suspicion, we did not perform a skin biopsy or request any other tests.</p><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Shiitake dermatitis.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Symptomatic treatment with topical corticosteroids and oral antihistamines was initiated. New lesions continued to appear for 48<span class="elsevierStyleHsp" style=""></span>hours. The condition then gradually improved and resolved completely within 2 weeks, leaving transient residual hyperpigmentation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The shiitake mushroom (<span class="elsevierStyleItalic">Lentinus edodes</span>) is very common in Chinese and Japanese cuisine. Shiitake dermatitis has been known in Asian countries for many years<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and is becoming better known in the West as consumption of shiitake mushrooms becomes more widespread.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> This form of dermatitis is highly distinctive, with highly pruritic, erythematous papules and plaques scattered across the skin in a linear or flagellate pattern. The lesions are found primarily on the trunk and limbs and may also affect the face and neck. The eruption appears 24–48<span class="elsevierStyleHsp" style=""></span>hours after ingestion of raw or undercooked shiitake mushrooms and resolves within a week.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The diagnosis is usually made on a clinical basis because histology of the lesions shows nonspecific spongiotic dermatitis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Patch tests and prick tests are usually negative.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> Shiitake dermatitis is a toxic reaction caused by thermolabile polysaccharides such as lentinan that are found in shiitake mushrooms.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The main condition that should be considered in the differential diagnosis is flagellate erythema associated with dermatomyositis<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> or caused by bleomycin treatment. Allergic conditions such as conjunctivitis, rhinitis, asthma, and contact dermatitis have also been reported in shiitake mushroom growers.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Shiitake dermatitis is treated symptomatically. The condition does not recur so long as the patient avoids eating shiitake mushrooms that are not fully cooked.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We present the case of this unusual mushroom-induced toxic eruption because the increasing prevalence of shiitake mushroom consumption could lead to new cases in Western countries. This case is of additional interest because it occurred in a pregnant woman.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Diagnosis" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical Course and Treatment" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Comment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of Interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: López-Núñez M, et al. Gestante con erupción flagelada. Actas Dermosifiliogr.2012;103:155–6.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1333 "Ancho" => 892 "Tamanyo" => 98231 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 667 "Ancho" => 1002 "Tamanyo" => 53075 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1333 "Ancho" => 957 "Tamanyo" => 100862 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shiitake (<span class="elsevierStyleItalic">Lentinus edodes</span>) dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. 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| 2024 July | 84 | 35 | 119 |
| 2024 June | 95 | 40 | 135 |
| 2024 May | 87 | 33 | 120 |
| 2024 April | 108 | 31 | 139 |
| 2024 March | 98 | 37 | 135 |
| 2024 February | 79 | 39 | 118 |
| 2024 January | 83 | 45 | 128 |
| 2023 December | 131 | 19 | 150 |
| 2023 November | 101 | 30 | 131 |
| 2023 October | 152 | 29 | 181 |
| 2023 September | 99 | 30 | 129 |
| 2023 August | 74 | 23 | 97 |
| 2023 July | 130 | 41 | 171 |
| 2023 June | 119 | 27 | 146 |
| 2023 May | 117 | 23 | 140 |
| 2023 April | 93 | 25 | 118 |
| 2023 March | 74 | 27 | 101 |
| 2023 February | 78 | 22 | 100 |
| 2023 January | 81 | 27 | 108 |
| 2022 December | 55 | 39 | 94 |
| 2022 November | 45 | 30 | 75 |
| 2022 October | 51 | 30 | 81 |
| 2022 September | 43 | 48 | 91 |
| 2022 August | 37 | 31 | 68 |
| 2022 July | 29 | 34 | 63 |
| 2022 June | 45 | 27 | 72 |
| 2022 May | 73 | 41 | 114 |
| 2022 April | 98 | 39 | 137 |
| 2022 March | 92 | 59 | 151 |
| 2022 February | 77 | 60 | 137 |
| 2022 January | 86 | 69 | 155 |
| 2021 December | 61 | 57 | 118 |
| 2021 November | 61 | 52 | 113 |
| 2021 October | 83 | 77 | 160 |
| 2021 September | 79 | 69 | 148 |
| 2021 August | 83 | 90 | 173 |
| 2021 July | 80 | 41 | 121 |
| 2021 June | 61 | 33 | 94 |
| 2021 May | 56 | 49 | 105 |
| 2021 April | 169 | 103 | 272 |
| 2021 March | 146 | 45 | 191 |
| 2021 February | 82 | 41 | 123 |
| 2021 January | 67 | 27 | 94 |
| 2020 December | 48 | 26 | 74 |
| 2020 November | 51 | 30 | 81 |
| 2020 October | 60 | 25 | 85 |
| 2020 September | 62 | 19 | 81 |
| 2020 August | 39 | 22 | 61 |
| 2020 July | 72 | 30 | 102 |
| 2020 June | 55 | 32 | 87 |
| 2020 May | 41 | 32 | 73 |
| 2020 April | 35 | 23 | 58 |
| 2020 March | 35 | 29 | 64 |
| 2020 February | 8 | 7 | 15 |
| 2020 January | 0 | 5 | 5 |
| 2019 December | 4 | 12 | 16 |
| 2019 November | 0 | 7 | 7 |
| 2019 October | 0 | 6 | 6 |
| 2019 September | 4 | 15 | 19 |
| 2019 August | 0 | 8 | 8 |
| 2019 July | 0 | 16 | 16 |
| 2019 June | 2 | 27 | 29 |
| 2019 May | 0 | 79 | 79 |
| 2019 April | 0 | 63 | 63 |
| 2019 March | 2 | 11 | 13 |
| 2019 February | 0 | 10 | 10 |
| 2019 January | 2 | 13 | 15 |
| 2018 December | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 1 | 1 | 2 |
| 2018 August | 0 | 8 | 8 |
| 2018 July | 0 | 3 | 3 |
| 2018 June | 0 | 7 | 7 |
| 2018 May | 0 | 2 | 2 |
| 2018 April | 0 | 9 | 9 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 89 | 15 | 104 |
| 2018 January | 88 | 8 | 96 |
| 2017 December | 120 | 10 | 130 |
| 2017 November | 77 | 7 | 84 |
| 2017 October | 75 | 12 | 87 |
| 2017 September | 100 | 11 | 111 |
| 2017 August | 133 | 14 | 147 |
| 2017 July | 101 | 10 | 111 |
| 2017 June | 114 | 19 | 133 |
| 2017 May | 108 | 18 | 126 |
| 2017 April | 103 | 9 | 112 |
| 2017 March | 58 | 37 | 95 |
| 2017 February | 50 | 29 | 79 |
| 2017 January | 62 | 20 | 82 |
| 2016 December | 82 | 12 | 94 |
| 2016 November | 135 | 10 | 145 |
| 2016 October | 180 | 21 | 201 |
| 2016 September | 192 | 9 | 201 |
| 2016 August | 201 | 11 | 212 |
| 2016 July | 60 | 8 | 68 |
| 2016 June | 8 | 9 | 17 |
| 2016 May | 14 | 17 | 31 |
| 2016 April | 5 | 1 | 6 |
| 2016 March | 8 | 4 | 12 |
| 2016 February | 17 | 2 | 19 |
| 2016 January | 8 | 1 | 9 |
| 2015 December | 8 | 1 | 9 |
| 2015 November | 35 | 1 | 36 |
| 2015 October | 43 | 2 | 45 |
| 2015 September | 15 | 4 | 19 |
| 2015 August | 10 | 2 | 12 |
| 2015 July | 158 | 9 | 167 |
| 2015 June | 80 | 12 | 92 |
| 2015 May | 86 | 17 | 103 |
| 2015 April | 88 | 12 | 100 |
| 2015 March | 131 | 9 | 140 |
| 2015 February | 92 | 15 | 107 |
| 2015 January | 70 | 12 | 82 |
| 2014 December | 102 | 7 | 109 |
| 2014 November | 111 | 7 | 118 |
| 2014 October | 131 | 17 | 148 |
| 2014 September | 109 | 10 | 119 |
| 2014 August | 125 | 13 | 138 |
| 2014 July | 108 | 15 | 123 |
| 2014 June | 124 | 12 | 136 |
| 2014 May | 133 | 18 | 151 |
| 2014 April | 149 | 14 | 163 |
| 2014 March | 137 | 16 | 153 |
| 2014 February | 79 | 9 | 88 |
| 2014 January | 81 | 9 | 90 |
| 2013 December | 90 | 10 | 100 |
| 2013 November | 62 | 9 | 71 |
| 2013 October | 36 | 5 | 41 |
| 2013 September | 23 | 5 | 28 |
| 2013 August | 44 | 9 | 53 |
| 2013 July | 53 | 16 | 69 |
| 2013 June | 32 | 20 | 52 |
| 2013 May | 13 | 7 | 20 |
| 2013 April | 21 | 15 | 36 |
| 2013 March | 22 | 6 | 28 |
| 2013 February | 53 | 6 | 59 |
| 2013 January | 120 | 6 | 126 |
| 2012 December | 65 | 3 | 68 |
| 2012 November | 1 | 2 | 3 |
| 2012 October | 0 | 1 | 1 |
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