Case Report: Paederus Dermatitis in the Returning Traveler

Abstract

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 Pseudomonas 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.

Figure 1.

Images of affected right lower extremity. (A) Initial presentation, (B) after 16 days, and (C) after 4 months with notable hypopigmentation with surrounding hyperpigmentation. This figure appears in color at www.ajtmh.org.

Figure 2.

Rove beetle—Paederus littoralis—a related species from Portugal. Photo courtesy of www.entomart.be. This figure appears in color at www.ajtmh.org.

Figure 3.

Biopsy of right lower extremity; note eosinophilic (E) and Lymphocytic (L) infiltrate (×100 magnification). This figure appears in color at www.ajtmh.org.