Hemorraghic skin syndrome associated with contact of Lonomia spp. caterpillar: First report from the Ecuadorian Amazon

This is the first report of hemorrhagic cutaneous syndrome induced by contact with venomous caterpillars in a 29-year-old woman living in the northern Ecuadorian Amazon. Reported cases of hemorrhagic cutaneous syndrome are rare and are characterized by dermal lesions, systemic bleeding, and coagulation abnormalities. The woman had contact on her right thigh with caterpillars resting on the trunk of a tree which resulted in local irritation and pain, headache, dizziness, and vomiting. After 48 hours, ecchymosis occurred at the contact site, the neck, thorax, abdomen, and extremities. She was hospitalized and presented abundant vaginal bleeding and extended coagulation times with a normal platelet count. She was treated with paracetamol and tranexamic acid, achieving resolution of the bleeding and normalization of coagulation parameters. The patient was discharged in good condition; at the six-month follow-up, she remained asymptomatic. Although Lonomia spp. caterpillars are recorded in the Ecuadorian Amazon, this is the first reported case. This report highlights the unavailability of antilonomic serum in the region, underlining the need for implementing strategies to guarantee serum access and promoting medical and community awareness of hemorrhagic cutaneous syndrome by contact with Lonomia spp. in endemic areas.