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Anais Brasileiros de Dermatologia
Print version ISSN 0365-0596
An. Bras. Dermatol. vol.85 no.3 Rio de Janeiro June 2010
http://dx.doi.org/10.1590/S0365-05962010000300018
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 LimaI; João Luiz Costa CardosoII; Antônio MagelaIII; Francisco G. M. de OliveiraIV; Sinésio TalhariV; Vidal Haddad JuniorVI
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
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 ]
Approved by the Editorial Board and accepted
for publication on 06.02.2010. * Study carried
out in the Amazonas Foundation of Tropical Medicine - Manaus (AM), Brazil.
Mailing Address:
Vidal Haddad Junior
Caixa Postal 557
18618 000 - Botucatu, SP - Brasil
Tel./fax: 14 3882 4922
e-mail: haddadjr@fmb.unesp.br
Conflict of interest: None
Financial funding: None