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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 24  |  Issue : 1  |  Page : 57-58

Shiitake mushroom-induced flagellate dermatitis: Case report


Department of Dermatology, Tufts Medical Center, Tufts School of Medicine, Boston, MA, USA

Date of Submission19-Nov-2019
Date of Acceptance29-Dec-2019
Date of Web Publication27-Mar-2020

Correspondence Address:
Dr. Abdullah Aleisa
Department of Dermatology, Tufts Medical Center, Tufts School of Medicine, 260 Tremont St, 14th Floor, Boston 02116, MA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_73_19

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  Abstract 


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

How to cite this URL:
Aleisa A, Plotnikova N. Shiitake mushroom-induced flagellate dermatitis: Case report. J Dermatol Dermatol Surg [serial online] 2020 [cited 2020 Oct 20];24:57-8. Available from: https://www.jddsjournal.org/text.asp?2020/24/1/57/281432




  Introduction Top


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.[1] Other presentations include maculopapular, vesicular, and pustular have been reported.[2] We present a case of SM dermatitis in a healthy 18-year-old male.


  Case Report Top


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.
Figure 1: Linear, whiplash-like erythematous plaques on the trunk

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Figure 2: The edematous nature of the plaques

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  Discussion Top


SM-induced flagellate dermatitis is a rare self-resolving condition that lasts from 2 days up to 6 weeks.[3] 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.[3] 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.[1]

Histological findings include spongiosis and perivascular lymphocytic infiltrate. Like the bleomycin-induced eruption, findings are nonspecific.[4]

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Netchiporouk E, Pehr K, Ben-Shoshan M, Billick RC, Sasseville D, Singer M. Pustular flagellate dermatitis after consumption of shiitake mushrooms. JAAD Case Rep 2015;1:117-9.  Back to cited text no. 1
    
2.
Adler MJ, Larsen WG. Clinical variability of shiitake dermatitis. J Am Acad Dermatol 2012;67:e140-1.  Back to cited text no. 2
    
3.
Loo HV, Oon HH. Flagellate dermatitis following consumption of shiitake mushroom. Dermatol Reports 2011;3:e21.  Back to cited text no. 3
    
4.
Czarnecka AB, Kreft B, Marsch WC. Flagellate dermatitis after consumption of Shiitake mushrooms. Postepy Dermatol Alergol 2014;31:187-90.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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