Diagnosic Dilemma No. 12 

Contributor: Emeritus Professor John Goldsmid, University of Tasmania

This 18 y.o. Rhodesian soldier presented with the lesions shown in Fig.1 after returning from a patrol in the northern areas of what is now Zimbabwe The blisters were on his midriff and appeared to have a dermatomal distribution, suggesting zoster (shingles).
His young age, however, suggested that the diagnosis, while possible, might not be so simple. A careful history elicited the fact that the blisters had appeared after be had brushed a bright coloured insect off his skin in the region where the blisters later appeared. What is your diagnosis? Has the young man got shingles or does the history suggest an alternative diagnosis?
Image 1
Fig. 12.1 - Lesions seen on the skin of the soldier

What is your diagnosis?


These blister-like lesions were caused by contact with a blister beetle belonging to the genus Paederus (Fig.2). These beetles are widespread, being recorded from Africa, Latin America, the USA, SE Asia, Northern Australia, Asia, and Europe. They secrete an irritant toxin called paederin which causes the skin lesions
Image 2
Fig. 12.2: Paederus beetle

Alexander, J.O’D. (1984). Arthropods and Human Skin. Springer-Verlag. Berlin.

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