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Report of a Case. A 33-year-old man was admitted be- Comment. Cases of centipede bites have been observed
cause of acute edema involving the right hand (Figure 1). in Israel, Japan, Taiwan, the Philippines, the United
The patient reported that he was in good general health States, and Australia, where the largest number of cases
and that he was not taking any medication. The reac- has been reported (n=48).1 Centipede bites, which usu-
tion appeared 2 days before admission, during a trip to ally occur on the hands or feet, can be caused by Scolo-
Malaysia. The patient reported that he had been bitten pendra angulata, Scolopendra gigantea, Scolopendra
by a centipede as he lay sleeping in the garden of a ho- heros, Scolopendra morsitans, S subspinipes, and Scolo-
tel. Despite acute burning of the hand, the patient, a pro- pendra viridicornis nigra.1 The venom of S morsitans, S
fessional biologist, was able to capture the 20-cm-long subspinipes, and S viridicornis contains 14 proteins, 13
centipede and bring it to Milan, where it was classified lipoproteins, and several lipids and enzymes: S subspin-
as a specimen of S subspinipes (Figure 2). ipes venom contains scolopendrine, a quinoline alka-
Dermatologic examination revealed a severe, slightly loid active against bacteria and fungi; S viridicornis
erythematous edema involving the entire right hand. venom contains 5-hydroxytryptamine; and S subspin-
Vesicles, blisters, and pustules were also present. The pa- ipes dehaani venom induces histamine release.
tient complained of severe pain, fever (temperature, Erythema,2,3 edema,2-4 hemorrhagic vesicles,4 blis-
ters,4 and necrosis may appear minutes, hours, or days
after the bite. Rare cases of local numbness, paresthesia
at the site of the bite,3,5 and bacterial superinfections with
lymphangitis and lymphadenitis2 have also been de-
scribed. Pain is the most frequent symptom.1,2,5 Some pa-
tients also complain of burning2 and itching.1,4 In addi-
tion, several systemic manifestations, some of them very
severe, have been reported in the literature: pericoroni-
tis, nausea, vomiting, headache,2 cold sweating, anxi-
ety,2 dizziness,2 blurry vision, loss of consciousness, mul-
tiple neuropathies, fever,4 dyspnea, irregular peripheral
pulses,2 myocardial infarction, rhabdomyolysis, protein-
uria, acute renal failure, and abnormalities of coagulation.
The treatment of centipede bites consists of intrale-
sional or systemic analgesics,1-3 topical and/or systemic
corticosteroids,3 antihistamines,2 and systemic anti-
biotics in patients with bacterial superinfections. Ice
pack application and immersion in hot water (to exploit
the sensitivity of centipede venoms to high and low
cm 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Figure 1. Severe, mildly erythematous edema involving the entire right hand. Figure 2. Scolopendra subspinipes. The scale bar indicates centimeters, and
Vesicles, blisters, and pustules are also present. the inset shows a closer view of the head, buccal apparatus, and fangs.
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A B
C D
Figure 1. Clinical (A) and computed tomography angiography (CTA) images (B-D) of dilated scalp arteries. A, The prominent scalp artery outlined with the box
was easily palpable during examination (inset shows artery half surrounded by arrows). B, The CTA imaging reveals underlying dilated scalp arteries. C, The
arteries form an extraosseous medusalike confluence. D, Branches of the bilateral occipital and superficial temporal arteries centered near the sagittal sinus are
associated with a dilated large intracranial varix.
(REPRINTED) ARCH DERMATOL/ VOL 146 (NO. 7), JULY 2010 WWW.ARCHDERMATOL.COM
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