IMAGES IN TROPICAL DERMATOLOGY

Exogenous pigmentation in toes feigning ischemia of the extremities: a diagnostic challenge brought by arthropods of the Diplopoda Class ("millipedes")^*

Carlos Alberto Jatobá Lima^I; João Luiz Costa Cardoso^II; Antônio Magela^III; Francisco G. M. de Oliveira^IV; Sinésio Talhari^V; Vidal Haddad Junior^VI

^IVeterinarian, Management of Poisonous Animals, Amazonas Foundation of Tropical Medicine - Manaus (AM), Brazil
^IIMedical Doctor, Management of Poisonous Animals, Amazonas Foundation of Tropical Medicine - Manaus (AM), Brazil
^IIIMedical Doctor, Management of Poisonous Animals, Amazonas Foundation of Tropical Medicine - Manaus (AM), Brazil
^IVMedical Doctor, Management of Poisonous Animals, Amazonas Foundation of Tropical Medicine - Manaus (AM), Brazil
^VDermatologist, President Director, Amazonas Foundation of Tropical Medicine - Manaus (AM), Brazil
^VIDermatologist, Assistant Professor, Botucatu Medical School, São Paulo State University - São Paulo (SP), Brazil

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ABSTRACT

A 24 year-old patient reported having stepped on a millipede. When examined the patient presented cyanotic and erythematous macules on the first three toes of his right foot, and also complained of local pain and paresthesia, with palpable arterial flows. Millipedes are cylindrical segmented arthropods that when threatened form into curls and release quinones and other irritant and pigmentary substances. The cyanotic color reminds ischaemic tissular distress fact that may confuse professionals in Emergency Rooms when the clinical report is unclear.

Keywords: Dermatology; Brazil; Arthropods; Animals, poisonous

A 24-year-old male patient was examined in the morning of 6th August 2009, reporting that he had stepped on a "millipede". On that occasion it was observed cyanotic and erythematous macules on the first three toes of his right foot, and the patient also complained of local pain and paresthesia (Figure 1). The patient presented palpable arterial flows and absence of cutaneous necrosis. The procedure followed was analgesia and observation. After some days the inflammatory characteristics had disappeared but the hyperchromic pigmentation (actually, brown colour) was still present in December, 2009.

The "millipedes" called in Portuguese language "gongolôs" or "embuás" are cylindrical segmented arthropods of the Diplopoda Class that when threatened form into curls and release quinones and other irritant and pigmentary substances to defend themselves (Figures 2 and 3)^1,2. The cyanotic color reminds ischaemic tissular distress that may confuse professionals in Emergency Rooms when the clinical report is not clear. The pigmentation remains for months.^1,2

REFERENCES

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 ]