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Revista da Sociedade Brasileira de Medicina Tropical

versão impressa ISSN 0037-8682versão On-line ISSN 1678-9849

Rev. Soc. Bras. Med. Trop. vol.52  Uberaba  2019  Epub 18-Jul-2019 

Images in Infectious Diseases

An unusual dark macular lesion in the plantar region of a child

Vidal Haddad Júnior1

Daniel de Granville Manço2 

1Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil.

2Photo in Natur, Bonito, MS, Brasil.

A 7-year-old male patient from Bonito (Mato Grosso do Sul State, Brazil) presented “dark spots" on his foot without previous manifestation (Figure A). Frightened by the tonality of the lesions, his mother sought medical care. The lesions disappeared after two months.

FIGURE A: Left: Hyperchromic macules in the calcanum region after three days and after one month. Right: Millipede (Diplopoda) in movement and in the defense position. 

Skin lesions caused by Diplopoda or millipedes (“piolhos-de-cobra”, embuás, gongolôs) are relatively common and occur when these myriapods penetrate the shoes and are compressed or crushed1,2. At this time, they release toxic substances, such as alkaloids and hydrogen cyanide, which cause moderate initial inflammation and long lasting hyperchromic pigmentation. This can lead to complex differential diagnoses, especially when located in the extremities of the elderly and diabetics, as they simulate arterial ischemia and necrosis. The macules of the patients are anomalous and the circular and concentric aspect reproduces the body shape of the animal curled up and justifies the publication3.

Ethical comments

The Ethics Committee of the Botucatu Medical School does not ask for authorization to publish isolated case reports.


We acknowledge the collaboration of Mrs. Liliam Ferrarezi for the assignment of the images used.


1. Haddad Jr V, Cardoso JLC, Rotta O, Eterovic A. Acidentes provocados por Millipede com manifestações dermatológicas: relato de dois casos. An Bras Dermatol. 2000;75: 471-4. [ Links ]

2. Cardoso JLC, França FOS, Hui FH, Malaque CMS, Haddad Jr V. Animais peçonhentos no Brasil: biologia, clínica e terapêutica dos acidentes. São Paulo: Editora Sarvier; 2003. p. 258-64. [ Links ]

3. Lima CAJ, Magela A, Talhari S, Cardoso JLC, Oliveira FGM, Haddad Jr V. Exogenous pigmentation in toes feigning ischemia of the extremities: a diagnostic challenge brought by arthropods of the Diplopoda Class (“Millipedes”). An Bras Dermatol . 2010;85(3):391-2. [ Links ]

Recebido: 07 de Janeiro de 2019; Aceito: 26 de Março de 2019

Corresponding author: Vidal Haddad Júnior.

Conflict of interest: The authors declare that there is no conflict of interest.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License