|Year : 2020 | Volume
| Issue : 1 | Page : 57-58
Shiitake mushroom-induced flagellate dermatitis: Case report
Abdullah Aleisa, Natalia Plotnikova
Department of Dermatology, Tufts Medical Center, Tufts School of Medicine, Boston, MA, USA
|Date of Submission||19-Nov-2019|
|Date of Acceptance||29-Dec-2019|
|Date of Web Publication||27-Mar-2020|
Dr. Abdullah Aleisa
Department of Dermatology, Tufts Medical Center, Tufts School of Medicine, 260 Tremont St, 14th Floor, Boston 02116, MA
Source of Support: None, Conflict of Interest: None
Shiitake mushroom (SM)-induced flagellate dermatitis follows the ingestion of undercooked SMs. Pathogenesis is thought to be a delayed-type hypersensitivity reaction to lentinan, a heat-sensitive polysaccharide found in SM. Eruption is self-resolving and lasts from 2 days to 6 weeks. It presents as pruritic, linear, whiplash-like, erythematous plaques on the trunk. Flagellate eruption differential diagnoses include bleomycin-induced dermatitis, dermatomyositis, and adult-onset Still's disease.
Keywords: Dermatitis, flagellate, lentinan, shiitake mushroom, whiplash
|How to cite this article:|
Aleisa A, Plotnikova N. Shiitake mushroom-induced flagellate dermatitis: Case report. J Dermatol Dermatol Surg 2020;24:57-8
| Introduction|| |
Shiitake mushroom (SM) flagellate dermatitis is a rare condition first described by Nakamura in 1977. It presents with pruritic, linear, whiplash-like erythematous plaques favoring the trunk. Other presentations include maculopapular, vesicular, and pustular have been reported. We present a case of SM dermatitis in a healthy 18-year-old male.
| Case Report|| |
An 18-year-old Indian male with no significant medical history presented to the dermatology clinic for the evaluation of constant itchy red lines on his back, shoulders, and upper thighs present for 6 days. The patient never had a similar rash before, denied exacerbation with sun exposure, or any systemic symptoms. On further questioning, he reported ingestion of undercooked SMs 2 days before and 1 day after the onset of eruption. On examination, he had multiple erythematous, linear, blanching, edematous, thin plaques without excoriations or dermatographism on the back, shoulders, less on chest and anterior thighs [Figure 1] and [Figure 2]. Examination and history were consistent with SM-induced flagellate dermatitis. The patient was started on topical betamethasone dipropionate ointment 0.05% twice a day and reported complete resolution of his rash and pruritus in 1 week.
| Discussion|| |
SM-induced flagellate dermatitis is a rare self-resolving condition that lasts from 2 days up to 6 weeks. Pathogenesis is hypothesized to be due to toxicity or delayed-type hypersensitivity reaction to lentinan, a polysaccharide present in the cell wall of SM, leading to overexpression of interlukin-1 and vasodilation. Heat may play a role in denaturing lentinan and preventing dermatitis in well-cooked SMs. Flagellate eruption differential diagnoses include bleomycin-induced dermatitis, dermatomyositis, and adult-onset Still's disease.
Skin prick testing in SM-induced flagellate dermatitis is usually reactive to raw SM in delayed readings. Patch testing was found to be negative in patients with systemic SM-induced flagellate dermatitis with delayed reactive skin prick testing.
Histological findings include spongiosis and perivascular lymphocytic infiltrate. Like the bleomycin-induced eruption, findings are nonspecific.
SM-induced dermatitis remains a rare presentation even with the rapidly growing consumption of SM. It is important to keep SM-induced dermatitis on differential and ask about pertinent exposures, keeping in mind variable clinical presentations that have been reported.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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[Figure 1], [Figure 2]