A curious case of bed bugs, and a lesson of referral caution

An otherwise well 18 year old male backpacker presented to the Emergency Department with a pruritic eruption without systemic symptoms. He was referred to the dermatology registrar via telephone consultation. Clinical photographs were reviewed, and the lesions appeared excoriated, purpuric, and crusted. A vasculitic screen and biopsy were performed and the patient was referred for urgent outpatient dermatology review.
In-person consultation history and clinical examination were consistent with Cimex Lectularius (bedbug) bites sustained from backpacker accommodation; lesions showed a central punctum and traumatic purpura. Biopsy confirmed insect bite reaction. The patient was prescribed topical corticosteroids and oral antihistamines.
This case exemplifies the varying presentations of Cimex, which are becoming epidemic both in Australia and overseas1. It also showcases the importance of in-person dermatologist review, and caution in relying on photographs for clinical diagnosis.
1. Doggett, S., et al., Bed Bugs: The Australian Response. Insects, 2011. 2(2): p. 96

Dr. Anthea Mulcahy

St George Dermatology and Skin Cancer Centre

Dr Anthea Mulcahy is a clinical research fellow to Associate Professor Stephen Shumack and Dr Adrian Lim in Sydney, NSW. Anthea gained her medical degree from the University of Tasmania and moved to Sydney in 2015 to follow her passion of Dermatology.