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Oropharyngeal Edema in an 8-Month-Old Girl after Woolly Bear Caterpillar Exposure
Justin A MacKinnon1, George Waterman1, Kristina Piastro1
1Albany Medical Center, Albany, New York.
Insights
Lepidopterism, a rare condition from moth and caterpillar contact, can cause severe airway edema. Prompt recognition and treatment by emergency physicians are crucial for managing this potentially life-threatening reaction, especially in children.
Area of Science:
- Toxicology
- Pediatric Emergency Medicine
Background:
- Lepidopterism encompasses reactions to moths, butterflies, and caterpillars.
- Symptoms range from skin irritation to severe systemic reactions like anaphylaxis.
Observation:
- A case of severe airway edema in an infant due to oral exposure to Woolly Bear Caterpillar (Pyrrharctia Isabella) is detailed.
- This specific presentation in this species is novel to English literature.
Findings:
- Oral exposure to Woolly Bear Caterpillars can lead to life-threatening oropharyngeal edema.
- Emergency department recognition and prompt surgical airway management were required.
Implications:
- Emergency physicians must be aware of lepidopterism as a rare but serious differential diagnosis.
- Rapid identification and intervention are critical for favorable outcomes in pediatric airway compromise from caterpillar exposure.
Background:
Lepidopterism refers to the manifestations of contact from any number of moths, butterflies, and caterpillars. Various symptoms have been described, ranging from localized skin irritation to systemic anaphylactic reactions.
Case Report:
We present a case of airway edema in an 8-month-old child from oral exposure to Woolly Bear Caterpillar (Pyrrharctia Isabella). After prompt emergency department recognition, her symptoms necessitated urgent operating room management by a team of otolaryngologists and close monitoring in a pediatric intensive care unit. A similar presentation in this species has not been described previously in the English literature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Leptidopterism is rare, but recognition by the emergency practitioner is necessary for prompt and appropriate treatment. Rapid identification by the emergency physician of oral exposure and careful spine removal can be lifesaving in cases of significant oropharyngeal edema.
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