Unusual Presentation of Cactus Spines in the Flank of an Elderly Man: A Case Report

Andrea Suárez; Scott Freeman; Lauren Puls; Robert Dellavalle

Disclosures

J Med Case Reports. 2010;4(152) 

In This Article

Abstract and Introduction

Abstract

Introduction: Splinters and spines of plant matter are common foreign bodies in skin wounds of the extremities, and often present embedded in the dermis or subcutaneous tissue. Vegetative foreign bodies are highly inflammatory and, if not completely removed, can cause infection, toxic reactions, or granuloma formation. Older patients are at increased risk for infection from untreated plant foreign bodies. The most common error in plant splinter and spine management is failure to detect their presence.
Case presentation: Here we report a case of cactus spines in an 84-year-old Caucasian man presenting on the right flank as multiple, red papules with spiny extensions. This presentation was unusual both in location and the spinous character of the lesions, and only after punch biopsy analysis was a diagnosis of cactus matter spines made.
Conclusions: Our patient presented with an unusual case of cactus spines that required histopathology for identification. Skin lesions with neglected foreign bodies are a common cause of malpractice claims. If not removed, foreign bodies of the skin, particularly in elderly individuals, can result in inflammatory and infectious sequela. This report underscores the importance of thoroughly evaluating penetrating skin lesions for the presence of foreign bodies, such as splinters and spines.

Introduction

Plant splinters and spines are penetrating foreign bodies that commonly cause injury to the skin. They may be wood or thorns, and often involve the skin on the extremities. These foreign bodies can release toxins (histamine, acetylcholine or serotonin) or allergens, as well as potentially introduce fungal and bacterial pathogens into the wound.[1] When possible, they should be removed before inflammation or infection occurs. Because plant splinters and spines can penetrate deep into the skin, particularly when entering the skin perpendicularly, they often go undetected.[2] When unrecognized and left unremoved, they can cause inflammation, granuloma formation, and possibly localized or disseminated infection.[1,3] Elderly patients and the immunosuppressed are at increased risk for these negative outcomes.[4] We report a case of an elderly man with an uncharacteristic presentation of asymptomatic and unnoticed vertical and superficial plant spines requiring histopathological review to reach the diagnosis. To our knowledge, this is the first case report describing this unusual presentation for plant matter foreign bodies. This report emphasizes the utility of routine histopathology in plant splinter and spine detection, and underscores the importance of evaluating inexplicable skin wounds for the presence of foreign bodies.

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