1. CASE PRESENTATION
A 35‐year‐old man presented to the emergency department for evaluation of an itchy rash on his back. One day before the onset of the rash, he had eaten a meal containing raw shiitake mushrooms. The pruritus was severe in nature and had impaired his sleep and quality of life.
On physical examination, edematous flagellate plaques and linear patches were present across the entire back (Figure 1A,B). The patient was previously healthy and denied any recent medication intake. There was no dermographism, adenopathy, or any constitutional symptoms. There was no mucosal involvement as well.
FIGURE 1.
(A) Shiitake dermatitis. (B) Flagellate and linear plaques resembling whiplash marks on the back.
2. DIAGNOSIS
2.1. Shiitake flagellate dermatitis
The patient was reassured about the self‐limited nature of the condition. He was treated with oral cetirizine and clobetasol propionate 0.05% cream daily. The rash and pruritus completely resolved 1 week following treatment.
Shiitake dermatitis is an acute pruritic eruption that appears after ingestion of raw shiitake mushrooms. 1 It should be kept in mind in any patient presenting to the emergency department with flagellate edematous plaques on the trunk. 2 Systemic findings such as fever, diarrhea, and mucosal ulcers might be present sometimes. 3 Skin lesions simulate those found in bleomycin‐induced flagellate dermatitis, dermatomyositis, and adult‐onset Still's disease. 4 The recognition of this entity is essential due to the increased consumption of shiitake mushrooms worldwide. 5 The diagnosis is clinical, and the prognosis is favorable. Prevention is based on cooking shiitake mushrooms at a high temperature prior to ingestion. 6
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Saliba E, Estephan M. A whiplash‐shaped acute eruption. JACEP Open. 2024;5:e13159. 10.1002/emp2.13159
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