Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia.
Division of Infectious Disease, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia.
Am J Trop Med Hyg. 2018 May;98(5):1523-1525. doi: 10.4269/ajtmh.17-0976. Epub 2018 Mar 29.
Rash in the returned traveler can provide a diagnostic dilemma for clinicians, but a detailed history including epidemiologic exposures can allow prompt diagnosis of etiologies uncommon in the United States. One such disease is Paederus dermatitis, an irritant contact dermatitis related to exposure to the rove beetle characterized by bullous lesions with surrounding erythema. Although cases and outbreaks have commonly been reported throughout the world, they are rarely reported in travelers returning to the United States. Here, we describe a patient who presented to an academic medical center in Virginia after travel to Sierra Leone with clinical presentation including exposure history and histopathology consistent with Paederus dermatitis. Our patient's clinic course is described in detail including treatment. Usual treatment includes antihistamines, topical steroids, and oral antibiotics, particularly with antimicrobials with activity against sp. In addition, this case suggests a potential role for oral steroids in the treatment of this condition but further investigation is required. This case demonstrates the importance of considering a patient's travel and exposure history, as well as having familiarity with disease processes common in other parts of the world that are rarely seen in the United States.
旅行者出现皮疹可能会给临床医生带来诊断上的困惑，但详细的病史包括流行病学暴露史可以帮助快速诊断出美国少见的病因。其中一种疾病是 Paederus 皮炎，这是一种与接触隐翅虫有关的刺激性接触性皮炎，其特征为水疱性皮损伴周围红斑。虽然世界各地常有病例和暴发报告，但很少有旅行者返回美国后报告此类疾病。在此，我们描述了一名患者，他在前往塞拉利昂旅行后前往弗吉尼亚州的一所学术医疗中心就诊，临床表现包括与 Paederus 皮炎一致的暴露史和组织病理学。详细描述了我们患者的临床病程，包括治疗情况。通常的治疗方法包括抗组胺药、局部类固醇和口服抗生素，特别是具有针对 sp. 活性的抗生素。此外，该病例提示口服类固醇在该疾病治疗中的潜在作用，但需要进一步研究。该病例表明，考虑患者的旅行和暴露史以及熟悉世界其他地区少见但在美国很少见的疾病过程非常重要。
