Pigmentação exógena em pododáctilos simulando isquemia de extremidades: um desafio diagnóstico provocado por artrópodos da classe Diplopoda ("piolhos-de-cobra")

Abstract

Um paciente de 24 anos relatou ter pisado em um "piolho de cobra". Ao ser examinado, este apresentava máculas eritêmato-cianóticas, nos três primeiros pododáctilos do pé direito, com queixas de dor local e parestesias, com fluxos arteriais palpáveis. Os diplopodas são artrópodos cilíndricos segmentados que assumem posição enrodilhada - quando ameaçados - liberam quinonas e outros agentes irritativos e pigmentantes. A coloração de aspecto cianótico lembra sofrimento tissular isquêmico, o que pode confundir profissionais em atendimentos de Emergência, quando a história não apresenta clareza e coerência.

DOUBLE-BLIND STUDY WITH TOPICAL ISOCONAZOLE AND TERBINAFINE FOR THE TREATMENT OF ONE PATIENT WITH BILATERAL Tinea nigra plantaris AND SUGGESTIONS FOR NEW DIFFERENTIAL DIAGNOSIS

“…Commonly known as millipedes, they release quinones and other irritative and pigmentary substances when threatened or crushed 5 . When the liquids and vapors expelled come into contact with human skin, they cause a burning sensation 5 . The site of contact instantly becomes hyperchromic, ranging in color from light yellow to dark brown, and lasting up to several months (Fig.…”

Caracterização De Gongolos Coletados Na Caatinga

“…Os "piolhos-de-cobra", "gongolos", "gongogi" ou "embuás" como são conhecidos, são artrópodos cilíndricos segmentados da Classe Diplopoda, que assumem posição enrodilhada quando ameaçados, e liberam quinonas e outros agentes irritativos e pigmentantes para a sua defesa (Lima et al, 2010).…”

Millipede accident with unusual dermatological lesion

“…Millipedes are nocturnal animals that inhabit dark and humid places, and have two defense mechanisms: spiral curling (with the head in the center), providing greater resistance to the exoskeleton, and the discharge of an irritating secretion, which flows from glands on the lateral portion of each body segment when the animal is under threat or being crushed. The secretion can also be ejected from a distance 2, 3…”

“…These are mostly harmless animals; however, when defending themselves, they can excrete toxins that cause irritating and pigmenting chemical reactions in the skin 3, 4. Accidents with children and adults usually occur when they are unconscious, lying on the floor, or during contact with clothes and shoes, especially during the rainy season, when millipedes invade urban areas and houses in search of shelter in a dark place 5 .…”

“…Almost immediately after contact, there is numbness and a burning sensation on the skin 4 . The affected site becomes erythematous, with initially brownish-yellow pigmentation, darkening after 24 h and turning reddish-brown to black, with a cyanotic appearance, a coloration that may persist for several months 3 . Depending on the amount of secretion and exposure time, the pigmented lesion may dry out and peel in approximately seven days, or there may be blistering that, upon rupture, leaves the surface eroded 2…”