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erythematous&#44; pseudovesicular plaques &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; on the patient&#39;s trunk&#44; limbs&#44; and face &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; The lesions were not evanescent or scaly&#44; and they spared the periumbilical region&#46; No abdominal striae were visible&#46;</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&#44; we did not perform a skin biopsy or request any other tests&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis&#63;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Shiitake dermatitis&#46;</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&#46; New lesions continued to appear for 48<span class="elsevierStyleHsp" style=""></span>hours&#46; The condition then gradually improved and resolved completely within 2 weeks&#44; leaving transient residual hyperpigmentation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The shiitake mushroom &#40;<span class="elsevierStyleItalic">Lentinus edodes</span>&#41; is very common in Chinese and Japanese cuisine&#46; 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&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> This form of dermatitis is highly distinctive&#44; with highly pruritic&#44; erythematous papules and plaques scattered across the skin in a linear or flagellate pattern&#46; The lesions are found primarily on the trunk and limbs and may also affect the face and neck&#46; The eruption appears 24&#8211;48<span class="elsevierStyleHsp" style=""></span>hours after ingestion of raw or undercooked shiitake mushrooms and resolves within a week&#46;<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&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Patch tests and prick tests are usually negative&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Shiitake dermatitis is a toxic reaction caused by thermolabile polysaccharides such as lentinan that are found in shiitake mushrooms&#46;<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&#46; Allergic conditions such as conjunctivitis&#44; rhinitis&#44; asthma&#44; and contact dermatitis have also been reported in shiitake mushroom growers&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Shiitake dermatitis is treated symptomatically&#46; The condition does not recur so long as the patient avoids eating shiitake mushrooms that are not fully cooked&#46;</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&#46; This case is of additional interest because it occurred in a pregnant woman&#46;</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&#46;</p></span></span>"
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Case for Diagnosis
Pregnant Woman With Flagellate Erythema
Gestante con erupción flagelada
M. López-Núñez
Autor para correspondencia
marialopez1980@hotmail.com

Corresponding author.
, A. Jaka-Moreno, A. Tuneu-Valls
Sección de Dermatología, Hospital Donostia, San Sebastián, Spain
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    "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&#46; She was referred by the gynecology unit for treatment of a pruritic eruption that had appeared 3 days earlier&#46; The patient had no relevant past history and was not taking any regular medication&#46; Her pregnancy was progressing normally&#46; She was in the habit of taking walks in a rural area&#44; always with her trunk covered&#46; She had eaten at an Asian restaurant with her partner&#44; who had no skin lesions&#44; 2 days prior to the onset of symptoms&#46;</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&#44; erythematous&#44; pseudovesicular plaques &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; on the patient&#39;s trunk&#44; limbs&#44; and face &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; The lesions were not evanescent or scaly&#44; and they spared the periumbilical region&#46; No abdominal striae were visible&#46;</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&#44; we did not perform a skin biopsy or request any other tests&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis&#63;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Shiitake dermatitis&#46;</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&#46; New lesions continued to appear for 48<span class="elsevierStyleHsp" style=""></span>hours&#46; The condition then gradually improved and resolved completely within 2 weeks&#44; leaving transient residual hyperpigmentation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The shiitake mushroom &#40;<span class="elsevierStyleItalic">Lentinus edodes</span>&#41; is very common in Chinese and Japanese cuisine&#46; 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&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> This form of dermatitis is highly distinctive&#44; with highly pruritic&#44; erythematous papules and plaques scattered across the skin in a linear or flagellate pattern&#46; The lesions are found primarily on the trunk and limbs and may also affect the face and neck&#46; The eruption appears 24&#8211;48<span class="elsevierStyleHsp" style=""></span>hours after ingestion of raw or undercooked shiitake mushrooms and resolves within a week&#46;<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&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Patch tests and prick tests are usually negative&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Shiitake dermatitis is a toxic reaction caused by thermolabile polysaccharides such as lentinan that are found in shiitake mushrooms&#46;<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&#46; Allergic conditions such as conjunctivitis&#44; rhinitis&#44; asthma&#44; and contact dermatitis have also been reported in shiitake mushroom growers&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Shiitake dermatitis is treated symptomatically&#46; The condition does not recur so long as the patient avoids eating shiitake mushrooms that are not fully cooked&#46;</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&#46; This case is of additional interest because it occurred in a pregnant woman&#46;</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&#46;</p></span></span>"
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