[Flagellate dermatitis caused by the intake of shiitake mushrooms. A case report and review of the literature]

Rev Alerg Mex. 2020 Jan-Mar;67(1):79-82. doi: 10.29262/ram.v67i1.620.
[Article in Spanish]

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.

Keywords: Flagellate dermatitis; Food allergy; Shiitake mushrooms.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Dermatitis / immunology*
  • Dermatitis / pathology
  • Female
  • Food Hypersensitivity / complications*
  • Humans
  • Middle Aged
  • Shiitake Mushrooms*