Pancake syndrome diagnosed via mite detection in flour using smartphone macro photography

We present a case of pancake syndrome (PS) uniquely diagnosed using the macro photography function of a smartphone to detect mite contamination in flour. The patient was a 12-year-old girl with a history of allergic rhinitis who developed severe allergic symptoms, including wheezing and hypoxemia, immediately after consuming homemade Takoyaki-a Japanese dish made with a wheat flour-based batter and cooked in a molded pan-prepared with flour that had been stored at room temperature for several months. Emergency treatment with intramuscular epinephrine and intravenous corticosteroids led to symptom resolution. Based on her clinical history and elevated dust mite-specific IgE levels, PS was suspected. For diagnostic confirmation, the suspect flour was examined using the macro mode of an Apple iPhone 15 Pro, which successfully revealed live mites. This case highlights the potential utility of smartphones in emergency department settings for diagnosis, patient education, and preventive guidance.