title: Unusual presentation of cactus spines in the flank of an elderly man: a case report.
abstract: BACKGROUND
  Splinters and spines of plant matter are common foreign bodies in skin wounds of the extremities, and often present embedded in the dermis or subcutaneous tissue. Vegetative foreign bodies are highly inflammatory and, if not completely removed, can cause infection, toxic reactions, or granuloma formation. Older patients are at increased risk for infection from untreated plant foreign bodies. The most common error in plant splinter and spine management is failure to detect their presence.
  
  
  METHODS
  Here we report a case of cactus spines in an 84-year-old Caucasian man presenting on the right flank as multiple, red papules with spiny extensions. This presentation was unusual both in location and the spinous character of the lesions, and only after punch biopsy analysis was a diagnosis of cactus matter spines made.
  
  
  CONCLUSIONS
  Our patient presented with an unusual case of cactus spines that required histopathology for identification. Skin lesions with neglected foreign bodies are a common cause of malpractice claims. If not removed, foreign bodies of the skin, particularly in elderly individuals, can result in inflammatory and infectious sequela. This report underscores the importance of thoroughly evaluating penetrating skin lesions for the presence of foreign bodies, such as splinters and spines.
authors.affiliation: University of Colorado Hospital, Dermatology Clinic, Mail Stop F703, PO Box 6510, Aurora, CO 80045-0510, USA. robert.dellavalle@ucdenver.edu.
authors.forename: Andrea
authors.initials: A
authors.lastname: Suárez
authors.forename: Scott
authors.initials: S
authors.lastname: Freeman
authors.forename: Lauren
authors.initials: L
authors.lastname: Puls
authors.forename: Robert
authors.initials: R
authors.lastname: Dellavalle