Beware of the Beetle: A Case Report of Severe Vesicating Dermatitis

Outbreaks of Paederus dermatitis have been documented worldwide. A case of Paederus dermatitis from Ethiopia is presented to highlight the importance of this clinical entity in the deployed setting.

A 31-year-old male presented with a 3- day history of scattered areas of a purulent, vesicating erythematous rash to his mid-back and neck. The largest of these measured 5 × 7 cm with erythematous borders and an erosive center. One to 2 days prior, 15 troops reported similar and less severe vesicating lesions to their extremities and backs. All patients participated in the same outdoor recreational event. A survey of the event's location revealed signs of the Paederus beetle.

Although a known phenomenon, there are no literature reports of Paederus dermatitis within AFRICOM. Crushing the Paederus beetle against the skin causes an intense rash because of paederin in the hemolymph. Most present with typical linear lesions likely caused by brushing off the beetle from the skin. Fortunately, patients respond favorably to topical steroid treatment.

Paederus beetle exposure in the deployed setting can impact force health. Increased awareness among providers and personnel should mitigate potential exposure and limit the morbidity associated with this beetle.