Flagellate erythema: from diet, drugs to dermatomyositis

Cathy Y Zhao and Germana Consuegra‐Romero
Med J Aust 2020; 213 (8): . || doi: 10.5694/mja2.50784
Published online: 19 October 2020

A fit 75‐year‐old man presented with a one‐day history of a widespread flagellate‐patterned asymptomatic eruption involving the neck, trunk and upper arms (Figure). He had ingested undercooked shiitake mushrooms 48‐hours prior. The eruption resolved within a week with oral prednisolone 0.5 mg/kg/day prescribed for a faster recovery, which would otherwise occur spontaneously within 1–8 weeks. He was warned to avoid ingesting shiitake mushrooms again, although thorough cooking would likely prevent recurrence of the eruption. Flagellate erythema is a unique sign that can occur secondary to the 3Ds: diet (undercooked shiitake mushrooms), drugs (bleomycin/docetaxel), and more serious rheumatological conditions, such as dermatomyositis or adult‐onset Still's disease.

  • Cathy Y Zhao1,2
  • Germana Consuegra‐Romero1

  • 1 Westmead Hospital, Sydney, NSW
  • 2 University of Sydney, Sydney, NSW


Competing interests:

No relevant disclosures.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.