Case and research letters
Flagellate Dermatitis After Eating Shiitake Mushrooms
Dermatitis flagelada tras la ingesta de setas del género Shiitake
T. Díaz-Corpas
, A. Mateu-Puchades, M.N. Coll-Puigserver, A. Marquina-Vila
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Servicio de Dermatología, Hospital Universitario Dr. Peset, Valencia, Spain
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Díaz-Corpas, A. Mateu-Puchades, M.N. Coll-Puigserver, A. Marquina-Vila" "autores" => array:4 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Díaz-Corpas" "email" => array:1 [ 0 => "ainatdc@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Mateu-Puchades" ] 2 => array:2 [ "nombre" => "M.N." "apellidos" => "Coll-Puigserver" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Marquina-Vila" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Dr. Peset, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis flagelada tras la ingesta de setas del género Shiitake" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2000 "Ancho" => 1500 "Tamanyo" => 395154 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Crisscrossing linear erythematous lesions, primarily on the trunk.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The shiitake mushroom (<span class="elsevierStyleItalic">Lentinus edodes</span>), commonly eaten in China and Japan, is the second most widely consumed mushroom species worldwide and it is also becoming increasingly available in Western markets.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> In Japan, the shiitake mushroom is used as an antihypertensive or lipid-lowering agent and as adjuvant therapy against colorectal or gastric cancer because of the beneficial properties of its polysaccharide lentinan.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Flagellate dermatitis caused by the consumption of undercooked or raw shiitake mushrooms usually occurs 48-72<span class="elsevierStyleHsp" style=""></span>hours after ingestion. It presents as papular, petechial, or vesicular lesions in a crisscrossed, linear pattern, primarily on the trunk, upper limbs, neck, and face, accompanied by marked pruritus.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several authors have reported other adverse reactions to shiitake mushrooms, including allergic contact dermatitis, phototoxicity, contact urticaria, allergic asthma, and isolated cases of chronic hypersensitivity pneumonitis induced by shiitake spores.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of a 79-year-old woman who visited our unit for an emergency examination of a very itchy rash 72<span class="elsevierStyleHsp" style=""></span>hours after onset. The only relevant medical history was that the patient was being monitored for chronic cutaneous lupus. The lesions had not responded to an intramuscular corticosteroid injection administered 24<span class="elsevierStyleHsp" style=""></span>hours earlier.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient reported eating grilled mushrooms 72<span class="elsevierStyleHsp" style=""></span>hours prior to the appearance of the lesions. She had not taken any medication prior to the onset of the cutaneous symptoms, and presented no fever, joint pain, or other systemic symptoms.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple crisscrossing linear erythematous lesions composed of petechiae that did not blanch with pressure. The lesions were located primarily on the trunk, neckline, and proximal areas of the upper and lower limbs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no mucosal involvement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Laboratory tests were normal, and a biopsy of one of the lesions revealed spongiotic dermatitis and slight blood extravasation in the superficial dermis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient returned for a follow-up visit 2 weeks later, by which time the lesions had completely resolved (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). She provided a sample of the mushrooms she had ingested prior to the appearance of the lesions. They belonged to the shiitake species (<span class="elsevierStyleItalic">L. edodes</span>), though it was unclear whether they had been imported (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The mushrooms were refrigerated and later used to carry out, in the patient and 10 healthy controls, Finn Chamber epicutaneous patch tests and scratch tests in which a Microlance 3 needle (0.5 x 16<span class="elsevierStyleHsp" style=""></span>mm) was used to prepare the surface of the skin without causing bleeding. The results were read 2, 48 and 72<span class="elsevierStyleHsp" style=""></span>hours after test administration. The patient's scratch test was positive at 48 and 96<span class="elsevierStyleHsp" style=""></span>hours, when it displayed marked erythema and vesiculation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), but her patch tests were negative. None of the controls had positive reactions in either hypersensitivity test.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Shiitake dermatitis was first described in a series of 23 cases published in 1977 by Nakamura,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who went on to publish a longer series in 1992.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> To date, approximately 100 cases have been reported worldwide, mostly in China and Japan, only a few in Europe,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and none in Spain.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Shiitake dermatitis appears in certain people following consumption of undercooked or raw shiitake mushrooms; this suggests that these individuals must be susceptible or hypersensitive to a thermolabile substance present in the mushroom.</p><p id="par0055" class="elsevierStylePara elsevierViewall">As biopsy results usually indicate nonspecific spongiotic dermatitis,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> shiitake dermatitis is diagnosed on the basis of the appropriate clinical signs and symptoms in a patient who has eaten undercooked or raw shiitake mushrooms.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4,8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It has a clinical picture similar to that of the flagellate dermatitis induced by drugs such as bleomycin,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> although the mechanism of action does not appear to be the same.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> While lentinan, the polysaccharide found in shiitake mushrooms, is thought to be responsible for the lesions of flagellate dermatitis<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4,8</span></a> due to the production of IL-1, the exact pathogenesis is poorly understood.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The negative patch test results cast doubt on the hypersensitivity hypothesis. However, the results of scratch and prick-to-prick test vary, and in some cases, like that of our patient, these tests have been positive.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> We therefore posit that the symptoms described were the result of a systemic allergic reaction to the shiitake mushroom.</p><p id="par0070" class="elsevierStylePara elsevierViewall">This is the first case of shiitake dermatitis to be reported in Spain, and it yielded a positive scratch test result. We believe that this case supports the hypothesis that this dermatitis is caused by a delayed hypersensitivity reaction and that cutaneous hypersensitivity tests could therefore be useful tools for diagnosing the condition and determining its exact pathogenesis, which remains unclear.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Díaz-Corpas T, et al. Dermatitis flagelada tras la ingesta de setas del género Shiitake. Actas Dermosifiliogr. 2011;102:830-832.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2000 "Ancho" => 1500 "Tamanyo" => 395154 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Crisscrossing linear erythematous lesions, primarily on the trunk.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1750 "Ancho" => 2337 "Tamanyo" => 302466 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Complete resolution of the lesions after 2 weeks.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1183 "Ancho" => 1585 "Tamanyo" => 180411 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Positive scratch test with vesiculation after 96<span class="elsevierStyleHsp" style=""></span>hours. Inset, bottom right: shiitake mushrooms provided by the patient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Toxicoderma caused by shiitake (<span class="elsevierStyleItalic">Lentinus edodes</span>)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 40 | 12 | 52 |
| 2024 Octubre | 220 | 62 | 282 |
| 2024 Septiembre | 279 | 68 | 347 |
| 2024 Agosto | 284 | 82 | 366 |
| 2024 Julio | 248 | 55 | 303 |
| 2024 Junio | 228 | 79 | 307 |
| 2024 Mayo | 270 | 88 | 358 |
| 2024 Abril | 188 | 35 | 223 |
| 2024 Marzo | 238 | 47 | 285 |
| 2024 Febrero | 237 | 47 | 284 |
| 2024 Enero | 187 | 57 | 244 |
| 2023 Diciembre | 205 | 54 | 259 |
| 2023 Noviembre | 173 | 47 | 220 |
| 2023 Octubre | 183 | 63 | 246 |
| 2023 Septiembre | 117 | 39 | 156 |
| 2023 Agosto | 91 | 50 | 141 |
| 2023 Julio | 136 | 46 | 182 |
| 2023 Junio | 164 | 29 | 193 |
| 2023 Mayo | 164 | 79 | 243 |
| 2023 Abril | 136 | 33 | 169 |
| 2023 Marzo | 177 | 51 | 228 |
| 2023 Febrero | 172 | 33 | 205 |
| 2023 Enero | 134 | 39 | 173 |
| 2022 Diciembre | 117 | 48 | 165 |
| 2022 Noviembre | 89 | 38 | 127 |
| 2022 Octubre | 69 | 19 | 88 |
| 2022 Septiembre | 82 | 39 | 121 |
| 2022 Agosto | 56 | 39 | 95 |
| 2022 Julio | 49 | 41 | 90 |
| 2022 Junio | 56 | 32 | 88 |
| 2022 Mayo | 106 | 42 | 148 |
| 2022 Abril | 124 | 47 | 171 |
| 2022 Marzo | 91 | 72 | 163 |
| 2022 Febrero | 110 | 39 | 149 |
| 2022 Enero | 127 | 53 | 180 |
| 2021 Diciembre | 90 | 55 | 145 |
| 2021 Noviembre | 110 | 49 | 159 |
| 2021 Octubre | 94 | 56 | 150 |
| 2021 Septiembre | 92 | 49 | 141 |
| 2021 Agosto | 80 | 44 | 124 |
| 2021 Julio | 64 | 40 | 104 |
| 2021 Junio | 85 | 48 | 133 |
| 2021 Mayo | 86 | 54 | 140 |
| 2021 Abril | 255 | 84 | 339 |
| 2021 Marzo | 165 | 41 | 206 |
| 2021 Febrero | 145 | 39 | 184 |
| 2021 Enero | 91 | 30 | 121 |
| 2020 Diciembre | 101 | 20 | 121 |
| 2020 Noviembre | 87 | 30 | 117 |
| 2020 Octubre | 54 | 24 | 78 |
| 2020 Septiembre | 71 | 26 | 97 |
| 2020 Agosto | 40 | 23 | 63 |
| 2020 Julio | 46 | 21 | 67 |
| 2020 Junio | 59 | 44 | 103 |
| 2020 Mayo | 54 | 35 | 89 |
| 2020 Abril | 32 | 19 | 51 |
| 2020 Marzo | 28 | 19 | 47 |
| 2020 Febrero | 3 | 0 | 3 |
| 2020 Enero | 4 | 5 | 9 |
| 2019 Diciembre | 6 | 2 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Agosto | 6 | 0 | 6 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 6 | 10 |
| 2019 Mayo | 4 | 31 | 35 |
| 2019 Abril | 2 | 7 | 9 |
| 2019 Marzo | 2 | 12 | 14 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Junio | 1 | 1 | 2 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 9 | 1 | 10 |
| 2018 Febrero | 140 | 10 | 150 |
| 2018 Enero | 158 | 21 | 179 |
| 2017 Diciembre | 155 | 15 | 170 |
| 2017 Noviembre | 137 | 17 | 154 |
| 2017 Octubre | 142 | 15 | 157 |
| 2017 Septiembre | 132 | 31 | 163 |
| 2017 Agosto | 126 | 30 | 156 |
| 2017 Julio | 137 | 28 | 165 |
| 2017 Junio | 150 | 40 | 190 |
| 2017 Mayo | 120 | 49 | 169 |
| 2017 Abril | 156 | 28 | 184 |
| 2017 Marzo | 97 | 29 | 126 |
| 2017 Febrero | 61 | 32 | 93 |
| 2017 Enero | 107 | 26 | 133 |
| 2016 Diciembre | 174 | 12 | 186 |
| 2016 Noviembre | 245 | 21 | 266 |
| 2016 Octubre | 284 | 19 | 303 |
| 2016 Septiembre | 392 | 20 | 412 |
| 2016 Agosto | 376 | 27 | 403 |
| 2016 Julio | 173 | 19 | 192 |
| 2016 Junio | 13 | 17 | 30 |
| 2016 Mayo | 6 | 17 | 23 |
| 2016 Abril | 5 | 2 | 7 |
| 2016 Marzo | 10 | 13 | 23 |
| 2016 Febrero | 5 | 1 | 6 |
| 2016 Enero | 7 | 12 | 19 |
| 2015 Diciembre | 9 | 6 | 15 |
| 2015 Noviembre | 10 | 1 | 11 |
| 2015 Octubre | 9 | 7 | 16 |
| 2015 Septiembre | 3 | 2 | 5 |
| 2015 Agosto | 14 | 2 | 16 |
| 2015 Julio | 144 | 16 | 160 |
| 2015 Junio | 72 | 6 | 78 |
| 2015 Mayo | 109 | 24 | 133 |
| 2015 Abril | 84 | 17 | 101 |
| 2015 Marzo | 74 | 16 | 90 |
| 2015 Febrero | 67 | 19 | 86 |
| 2015 Enero | 79 | 20 | 99 |
| 2014 Diciembre | 75 | 18 | 93 |
| 2014 Noviembre | 64 | 17 | 81 |
| 2014 Octubre | 74 | 24 | 98 |
| 2014 Septiembre | 55 | 22 | 77 |
| 2014 Agosto | 80 | 19 | 99 |
| 2014 Julio | 90 | 22 | 112 |
| 2014 Junio | 110 | 13 | 123 |
| 2014 Mayo | 106 | 19 | 125 |
| 2014 Abril | 89 | 15 | 104 |
| 2014 Marzo | 100 | 65 | 165 |
| 2014 Febrero | 84 | 51 | 135 |
| 2014 Enero | 80 | 56 | 136 |
| 2013 Diciembre | 82 | 36 | 118 |
| 2013 Noviembre | 29 | 45 | 74 |
| 2013 Octubre | 19 | 30 | 49 |
| 2013 Septiembre | 13 | 27 | 40 |
| 2013 Agosto | 16 | 25 | 41 |
| 2013 Julio | 15 | 50 | 65 |
| 2013 Junio | 14 | 37 | 51 |
| 2013 Mayo | 17 | 28 | 45 |
| 2013 Abril | 15 | 29 | 44 |
| 2013 Marzo | 12 | 23 | 35 |
| 2013 Febrero | 46 | 14 | 60 |
| 2013 Enero | 60 | 11 | 71 |
| 2012 Diciembre | 33 | 11 | 44 |
| 2012 Noviembre | 0 | 1 | 1 |
| 2012 Octubre | 0 | 2 | 2 |
| 2012 Julio | 1 | 0 | 1 |
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