title: Exogenous pigmentation in toes feigning ischemia of the extremities: a diagnostic challenge brought by arthropods of the Diplopoda Class ("millipedes").
abstract: A 24 year-old patient reported having stepped on a millipede. When examined the patient presented cyanotic and erythematous macules on the first three toes of his right foot, and also complained of local pain and paresthesia, with palpable arterial flows. Millipedes are cylindrical segmented arthropods that when threatened form into curls and release quinones and other irritant and pigmentary substances. The cyanotic color reminds ischaemic tissular distress fact that may confuse professionals in Emergency Rooms when the clinical report is unclear.
authors.affiliation: Fundação de Medicina Tropical do Amazonas, Manaus, AM, Brasil.
authors.forename: Carlos Alberto Jatobá
authors.initials: CA
authors.lastname: Lima
authors.forename: João Luiz Costa
authors.initials: JL
authors.lastname: Cardoso
authors.forename: Antônio
authors.initials: A
authors.lastname: Magela
authors.forename: Francisco G M de
authors.initials: FG
authors.lastname: Oliveira
authors.forename: Sinésio
authors.initials: S
authors.lastname: Talhari
authors.forename: Vidal
authors.initials: V
authors.lastname: Haddad Junior
mesh_terms: D000818:Animals; D001181:Arthropods; D001733:Bites and Stings / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D017495:Hyperpigmentation / Q000175:diagnosis* / Q000209:etiology*; D007511:Ischemia / Q000175:diagnosis*; D008297:Male; D014034:Toes / Q000098:blood supply*; D055815:Young Adult