Shiitake Dermatitis and Potential Implications for Military Readiness

Shiitake flagellate dermatitis is an intensely pruritic erythematous or violaceous eruption marked by "whip-like" linear streaks consisting of papules or plaques following the ingestion of undercooked shiitake mushrooms (Lentinula edodes). Most commonly localized on the trunk and upper limbs, the characteristic pattern of the rash is associated with the consumption of lentinan, a thermolabile toxin found within the mushroom, as well as a broad range of other dermatological conditions, including dermatomyositis, adult-onset Still's disease, and reactions to medications such as bleomycin. In this case report, we present a 24year-old active duty service member who presented to the clinic for the evaluation of a flagellate erythematous eruption on his abdomen, back, and extremities. As U.S. forces pivot to operating in austere and resource-limited settings in the Pacific, recognizing the spectrum of diagnoses encompassed by flagellate erythema is important for maintaining operational readiness and differentiating self-limited cutaneous manifestations from more serious underlying conditions associated with this finding.