Oropharyngeal manifestations of lepidopterism

Objective: To describe previously unreported oropharyngeal manifestations a nd management of caterpillar ingestion. Design: Retrospective case series. Setting: Tertiary; children's hospital. Patients: A total of 733 cases of exposure to caterpillars from January 1, 1994, to November 1, 1997, were reviewed. Twenty-six patients had oropharyn geal exposure with 8 patients ingesting the caterpillar. Ages ranged from I months to 7 years with 14 boys and 12 girls. Interventions: AII patients had a thorough examination of the oropharynx fo r caterpillar spines. For children who ingested a caterpillar, direct laryn goscopy, bronchoscopy, and esophagoscopy with removal of caterpillar spines were performed. Results: At the point of caterpillar contact, buried caterpillar spines wit h focal erythema were observed. The lips, tongue, and buccal mucosa were th e most frequently involved areas. The esophagus was involved in 8 of the pa tients. No postoperative complications were noted. Conclusion: With individualized care and prompt removal of venomous caterpi llar spines, complications are not likely to result from caterpillar ingest ion.