Shiitake dermatitis: two clinical forms of cutaneous presentation in the same patient / Dermatitis por shiitake: dos formas clínicas de presentación cutánea en un mismo paciente

La dermatitis por hongos Shiitake ocurre en un pequeño porcentaje de casos luego de la ingesta de este hongo en forma cruda o semi-cruda. Se manifiesta usualmente como una dermatosis flagelada localizada principalmente en la espalda y en forma más ocasional con otro tipo de lesiones incluyendo la urticaria, petequias y una dermatitis de contacto entre otras. Este estudio describe un paciente sano de 46 años con dos tipos diferentes de reacciones al hongo, espaciadas en el tiempo. Primero está la típica dermatosis flagelada luego de la ingesta del hongo Shiitake y un tiempo después luego de que se había mejorado completamente, un segundo rash en la forma de dermatitis de contacto con descamación y prurito de las manos y dedos luego de la manipulación del hongo. Según nuestro conocimiento, este es el primer caso con dos diferentes formas de presentación clínica de reacción alérgica al hongo Shiitake en el mismo paciente

Shiitake fungal dermatitis occurs in a small percentage of cases after ingestion of this raw or semi-raw mushroom. It usually manifests as flagellated dermatosis located mainly on the back and more rarely with other types of lesions, including urticaria, petechiae, and contact dermatitis, among others. This study described a healthy 46-year-old male patient who presented two different forms of reaction to mushrooms, spaced over time. First is the typical form of flagellated dermatosis after the Shiitake mushrooms ingestion, and shortly after, when fully recovered, with a second rash in the form of contact dermatitis with desquamation and itching of hands and fingers after the mushroom manipulation. To the best of our knowledge, this is the first case reported with two different cutaneous clinical forms of allergic reaction to Shiitake mushrooms in the same patient.

[Flagellate dermatitis caused by the intake of shiitake mushrooms. A case report and review of the literature]. / Dermatitis flagelada por setas shiitake. Reporte de un caso y revisión de la literatura.

BACKGROUND: Flagellate dermatitis caused by the intake of shiitake mushrooms is characterized by linear erythematous lesions that are intensely pruritic. It is common in countries where the consumption of mushrooms is high, but it is rare in Latin America. It can be difficult to diagnose as there is a delay between the intake of the mushroom and the eruption. CASE REPORT: A 49-year-old Caucasian woman with a history of hypothyroidism who, 48 hours after the intake of shiitake mushrooms, developed intense itching associated with the appearance of linear and erythematous lesions, in a "flagellate-like" pattern, predominantly on the trunk, without other signs or symptoms. There was no history of recent exposure to drugs. She was treated with oral antihistamine and topical corticosteroid, however, without improvement, which is why a short cycle of oral corticosteroid was required, with which her lesions were resolved. A shiitake-free diet was indicated. CONCLUSIONS: Flagellate dermatitis is a toxicoderma that is associated with the intake of shiitake mushrooms among other things. Its clinical presentation is characteristic, although its exact pathophysiology is not fully understood. The boom of Asian food in Latin America might lead to an increase in the number of cases; hence the importance of knowing about its existence.

Antecedentes: La dermatitis flagelada por setas shiitake se caracteriza por lesiones eritematosas lineales muy pruriginosas. Es común en países con alto consumo de hongos, pero poco frecuente en Latinoamérica. Puede ser difícil de diagnosticar debido al retraso en la aparición de las erupciones después de la ingesta del hongo. Caso clínico: Mujer caucásica de 49 años, con antecedente de hipotiroidismo, quien 48 horas después de la ingesta de setas shiitake desarrolló prurito intenso asociado a lesiones lineales, eritematosas, con patrón de flagelación, predominantes en tronco, sin otros signos ni síntomas. No había historia de exposición reciente a medicamentos. Recibió antihistamínico oral y corticoide tópico sin mejoría, por lo que requirió ciclo corto de corticoide oral, con el cual se resolvieron las lesiones. Se le indicó evitar el consumo del hongo en la dieta. Conclusiones: La dermatitis flagelada constituye una toxicodermia asociada, entre otras cosas, al consumo de setas shiitake. Su presentación clínica es característica, aunque su fisiopatología no está completamente entendida. El auge de la comida oriental en Latinoamérica podría incrementar el número de casos, de ahí la importancia de conocer esta toxicodermia.

Flagellate Dermatitis by Shiitake Mushroom.

The authors present a case of flagellate dermatitis in a previously healthy young male, triggered by the consumption of shiitake mushrooms. Complete remission without complications was obtained within 7 days, simply by the application of dexamethasone cream 0.1%. Considering the growing use of this originally Asian fungus in cookery worldwide, it is likely that we will see increased occurrence of this benign and self-limited condition also in the Western world.

Eritema flagelado por ingesta de hongos Shiitake: reporte de caso / Flagellated erythema due to Shiitake mushroom intake: report of case

El eritema flagelado es una erupción cutánea poco frecuente con múltiples causas, dentro de las cuales se encuentra la ingesta de hongos shiitake crudos o semicrudos. Se postula que es secundario a una reacción de hipersensibilidad Th-1 producida por el lentinan, un polisacárido termolábil de la pared celular del hongo. En años recientes ha aumentado su incidencia en el mundo occidental debido a la creciente popularidad de la comida asiática, en la que los hongos shiitake son un ingrediente muy utilizado. El cuadro clínico se caracteriza por la aparición de lesiones eritematosas lineales pruriginosas principalmente en tronco y extremidades, de curso autolimitado. El diagnóstico es principalmente clínico, basado en el antecedente de ingesta reciente de hongos shiitake y el rash característico y el tratamiento es sintomático con antihistamínicos y corticoides tópicos u orales. A continuación, presentamos un caso de eritema flagelado en una mujer joven, secundario a ingesta de hongos shiitake, que se resolvió completamente en 2 semanas.

Flagellate erythema is a rare skin eruption with many causes, including the ingestion of raw or undercooked shiitake mushrooms. It is thought to be a Th-1 hypersensitivity reaction produced by lentinan, a thermolabile polysaccharide found in the cell wall of the mushroom. In recent years, there has been an increase in the number of cases due to the growing popularity of Asian cuisine, in which shiitake mushrooms are a central ingredient. The clinical presentation is characterized by the appearance of linear, erythematous, pruritic lesions mostly on the trunk and extremities, of self-limited course. Diagnosis is mainly clinical, based on the history of recent shiitake mushroom ingestion and the characteristic rash, and treatment is symptomatic, with antihistamines and topical or systemic steroids. In this report, we present a case of flagellate erythema in a young woman, that appeared after the ingestion of shiitake mushrooms, and resolved completely after 2 weeks.

Flagellate dermatitis caused by shiitake mushrooms / Dermatite flagelada após a ingestão de fungos shiitake

Shiitake (Lentinus edodes) is the second most consumed mushroom in the world. It has long been known in Asian medicine for its anticarcinogenic, antihypertensive and serum cholesterol level reduction properties. Nevertheless, the consumption of raw or not well-cooked mushrooms may cause skin eruptions which usually occur 24 to 48 hours after ingestion and are characterized by linearly arranged pruritic erythematous papules and plaques. We present a 36-year-old patient that developed typical symptoms 24 hours after consumption of shiitake mushrooms and summarize therapeutic options and particularities of this disease.

Shiitake (Lentinus edodes) é o segundo tipo de cogumelo mais consumido no mundo. Suas propriedades terapêuticas antitumorais, anti-hipertensivas e redutoras dos níveis elevados de colesterol são há muito conhecidas pela população asiática. Após ingestão desse cogumelo, cru ou malcozido, podem desenvolver-se lesões eritematosas lineares, pruriginosas, que surgem após 24 ou 48 horas em todo o corpo. Apresentamos um paciente de 36 anos com anamnese e clínica típicos, e comentamos as alternativas terapêuticas e nuances dessa dermatose.

Temporal and spatial fluctuations of phytoplankton in a tropical coastal lagoon, southeast Brazil

Spatial and temporal variability of the phytoplankton community in the tropical coastal Imboassica lagoon, an environment naturally isolated from the ocean by a narrow sandbar, was analysed every two weeks for 19 months by sampling three sites. During this study, the lagoon received direct input of marine water three times, resulting in remarkable salinity, nutrient concentrations and phytoplankton biomass variations in both temporal and spatial aspects. The phytoplankton biomass presented relatively low values ranging, on average, from 0.54 mg.L-1 in the station closest to the sea (station 1) to 1.34 mg.L-1 in the station close to a macrophyte bank (station 3). Diatoms and cryptomonads dominated in stations 1 and 2 (located relatively close to station 1, yet receiving the runoff of domestic sewage), and euglenoids, cryptomonads and dinoflagellates at station 3. Stations 1 and 2 usually presented the same dominant species but station 2 presented a higher phytoplankton biomass. On the other hand, station 3 showed more similar results concerning phytoplankton biomass with station 2, however the dominant species were usually different. The high fluctuations of salinity and the reduced nutrient availability are pointed out as the main factors structuring the dynamics of the phytoplankton community at the Imboassica lagoon.

Variações espaciais e temporais da comunidade fitoplanctônica da lagoa Imboassica, um ambiente naturalmente isolado do oceano por uma estreita barra de areia, foram analisadas com base em coletas quinzenais, realizadas em três estações, durante 19 meses. Durante este estudo, a barra de areia foi rompida três vezes, resultando em acentuadas variações temporais e espaciais na salinidade, na concentração de nutrientes e na biomassa fitoplanctônica. Esta apresentou valores relativamente baixos, variando de 0,54 mg.L-1 na estação mais próxima ao mar (estação 1) a 1,34 mg.L-1 na estação próxima a um banco de macrófitas (estação 3). Diatomáceas e criptofíceas dominaram nas estações 1 e 2 (esta última localizada, relativamente próxima à estação 1, porém recebendo aporte de esgotos domésticos), e euglenofíceas, criptofíceas e dinofíceas na estação 3. As estações 1 e 2 apresentaram, de modo geral, as mesmas espécies dominantes, diferindo neste aspecto da estação 3, no entanto, esta diferiu significantemente apenas da estação 1, em termos de biomassa fitoplanctônica. As elevadas flutuações na salinidade e a reduzida disponibilidade de nutrientes são apontadas como os principais fatores estruturadores da dinâmica da comunidade fitoplanctônica na lagoa Imboassica.

Temporal and spatial fluctuations of phytoplankton in a tropical coastal lagoon, southeast Brazil

Spatial and temporal variability of the phytoplankton community in the tropical coastal Imboassica lagoon, an environment naturally isolated from the ocean by a narrow sandbar, was analysed every two weeks for 19 months by sampling three sites. During this study, the lagoon received direct input of marine water three times, resulting in remarkable salinity, nutrient concentrations and phytoplankton biomass variations in both temporal and spatial aspects. The phytoplankton biomass presented relatively low values ranging, on average, from 0.54 mg.L-1 in the station closest to the sea (station 1) to 1.34 mg.L-1 in the station close to a macrophyte bank (station 3). Diatoms and cryptomonads dominated in stations 1 and 2 (located relatively close to station 1, yet receiving the runoff of domestic sewage), and euglenoids, cryptomonads and dinoflagellates at station 3. Stations 1 and 2 usually presented the same dominant species but station 2 presented a higher phytoplankton biomass. On the other hand, station 3 showed more similar results concerning phytoplankton biomass with station 2, however the dominant species were usually different. The high fluctuations of salinity and the reduced nutrient availability are pointed out as the main factors structuring the dynamics of the phytoplankton community at the Imboassica lagoon.

Variações espaciais e temporais da comunidade fitoplanctônica da lagoa Imboassica, um ambiente naturalmente isolado do oceano por uma estreita barra de areia, foram analisadas com base em coletas quinzenais, realizadas em três estações, durante 19 meses. Durante este estudo, a barra de areia foi rompida três vezes, resultando em acentuadas variações temporais e espaciais na salinidade, na concentração de nutrientes e na biomassa fitoplanctônica. Esta apresentou valores relativamente baixos, variando de 0,54 mg.L-1 na estação mais próxima ao mar (estação 1) a 1,34 mg.L-1 na estação próxima a um banco de macrófitas (estação 3). Diatomáceas e criptofíceas dominaram nas estações 1 e 2 (esta última localizada, relativamente próxima à estação 1, porém recebendo aporte de esgotos domésticos), e euglenofíceas, criptofíceas e dinofíceas na estação 3. As estações 1 e 2 apresentaram, de modo geral, as mesmas espécies dominantes, diferindo neste aspecto da estação 3, no entanto, esta diferiu significantemente apenas da estação 1, em termos de biomassa fitoplanctônica. As elevadas flutuações na salinidade e a reduzida disponibilidade de nutrientes são apontadas como os principais fatores estruturadores da dinâmica da comunidade fitoplanctônica na lagoa Imboassica.