Oropharyngeal Edema in an 8-Month-Old Girl after Woolly Bear Caterpillar Exposure

MacKinnon, Justin A.; Waterman, G. A.; Piastro, Kristina; Oakes, Jennifer A.; Pauze, Denis R.

doi:10.1016/j.jemermed.2015.06.007

Cited by 4 publications

(4 citation statements)

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“…In the only other case of oral exposure to a woolly bear caterpillar reported in the literature, when the authors attempted to remove setae with forceps and tape from an 8-mo-old female infant’s mouth under ketamine sedation, the patient began developing oropharyngeal edema, prompting transition to the operating room for direct laryngoscopy and intubation as well as ongoing setae removal. 3 The authors noted that “the spines were friable and difficult to remove, and care had to be taken to ensure that they did not break off and remain embedded within the mucosa.” As far as is known, woolly bear caterpillars do not produce any known toxin or venom (M. Deane Bowers, PhD, written communication, November 2020). As such, the worsening edema and eventual need for intubation were presumably due to worsening mechanical irritation precipitated by the attempts to remove the setae.…”

Section: Discussionmentioning

confidence: 99%

“…5 Treatment after ingestion often involves removal of setae, antihistamines, topical or systemic steroids, and antibiotics. 1 -4…”

Section: Introductionmentioning

confidence: 99%

“…2 Although some patients remain asymptomatic, others present with pain, swelling, and redness at the site of exposure, drooling, refusal to drink, and/or urticarial rash. [1][2][3][4] Airway edema necessitating urgent endotracheal intubation has also been described. 5 Treatment after ingestion often involves removal of setae, antihistamines, topical or systemic steroids, and antibiotics.…”

Section: Introductionmentioning

confidence: 99%

“…5 Treatment after ingestion often involves removal of setae, antihistamines, topical or systemic steroids, and antibiotics. [1][2][3][4] In previous cases of symptomatic exposure to caterpillars reported in the English-language literature, setae removal was presented as a critical part of management. For example, in their poison center study of exposures to Lophocampa caryae, Kuspis et al 2 described 346 cases of symptomatic exposure; in each case, "initial patient management consisted of removal of hairs or spines," including in 22 children and 1 adult with oral exposure.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Nonsurgical Approach to Management of Lepidopterism due to Woolly Bear Caterpillar Ingestion

Halmo

Lackey

Gitomer

et al. 2023

Wilderness & Environmental Medicine

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Systemic symptoms resulting from exposure to members of the Lepidoptera order, such as moths, butterflies, and caterpillars, are known as lepidopterism. Most cases of lepidopterism are mild and result from dermal exposure to urticating hairs; ingestion is less common and generally more medically significant because the hairs may get embedded in the patient's mouth, hypopharynx, or esophagus, leading to dysphagia, drooling, edema, and possible airway obstruction. In previous cases of symptomatic caterpillar ingestion reported in the literature, extensive efforts, including direct laryngoscopy, esophagoscopy, and bronchoscopy, were undertaken to remove these hairs. We review the case of a 19-mo-old previously healthy male infant who presented to the emergency department with vomiting and inconsolability after ingesting half of a woolly bear caterpillar (Pyrrharctia isabella). His initial examination was notable for embedded hairs in his lips, oral mucosa, and right tonsillar pillar. The patient underwent a bedside flexible laryngoscopy, which revealed a single hair embedded in the epiglottis, without significant edema. He was stable from a respiratory standpoint and, thus, was admitted for observation and IV dexamethasone without any attempt to remove the hairs. He was discharged in good condition after 48 h; at a follow-up visit 1 wk later, no remaining hairs were visible. This case demonstrates that lepidopterism secondary to caterpillar ingestion is amenable to conservative management and does not require routine removal of urticating hairs in patients who do not show signs of airway distress.

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Section: Discussionmentioning

confidence: 99%

“…5 Treatment after ingestion often involves removal of setae, antihistamines, topical or systemic steroids, and antibiotics. 1 -4…”

Section: Introductionmentioning

confidence: 99%