Oropharyngeal manifestations of lepidopterism.

OBJECTIVE To describe previously unreported oropharyngeal manifestations and 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 oropharyngeal exposure with 8 patients ingesting the caterpillar. Ages ranged from 7 months to 7 years with 14 boys and 12 girls. INTERVENTIONS All patients had a thorough examination of the oropharynx for caterpillar spines. For children who ingested a caterpillar, direct laryngoscopy, bronchoscopy, and esophagoscopy with removal of caterpillar spines were performed. RESULTS At the point of caterpillar contact, buried caterpillar spines with focal erythema were observed. The lips, tongue, and buccal mucosa were the most frequently involved areas. The esophagus was involved in 8 of the patients. No postoperative complications were noted. CONCLUSION With individualized care and prompt removal of venomous caterpillar spines, complications are not likely to result from caterpillar ingestion.