-The case of a 70 year-old, previously healthy woman who developed a severe bleeding diathesis shortly after touching a Lonomia obliqua caterpillar and finally died from multiple intracerebral hemo rrhages is described. Brain hemorrhages are the leading cause of death in patients envenomed by the Lonomia species. The pertinent literature is reviewed and the most relevant clinical features highlighted, with emphasis on diagnosis. The use of new therapeutic options such as anti-Lonomia serum is discussed.KEY WORDS: intracerebral hemorrhage, Lonomia obliqua, caterpillar envenoming.Hemorragia intracerebral fatal causada por acidente com Lonomia obliqua: relato de caso RESUMO -O caso de uma mulher de 70 anos, previamente hígida, que desenvolveu diátese hemorrágica grave após contato com uma lagarta Lonomia obliqua, resultando em óbito por hemorragia intracere b r a l é relatado. Hemorragias cerebrais são uma das causas de morte em acidentes por Lonomia. A literatura p e rtinente é revisada, sendo as características clínicas e laboratoriais mais relevantes discutidas com ênfase para o diagnóstico, e o uso de novas abordagens terapêuticas como o soro anti-Lonomia. PALAVRAS-CHAVE: hemorragia intracerebral, Lonomia obliqua, envenenamento, lagartas urticantes.First described by Arocha-Pinango and Layrisse in Venezuela in 1967 1 , the hemorrhagic diathesis caused in humans by touching the Lonomia species begins with inflammatory changes at the site of envenoming, followed by systemic symptoms such as headache, f e v e r, vomiting and malaise. After 24 hours, a severe bleeding disorder ensues, leading to echimosis, hematuria, pulmonary and intracranial hemorrhages, and acute renal failure 2 . Two species of Lonomia a re known to cause the hemorrhagic syndrome, L o n o m i a achelous, found in Venezuela and the north of Brazil, and Lonomia obliqua, found in the south of Brazil 1 , 3 , 4 . Although there are diff e rences in the effect of the venom of both species, both venoms may lead to intense fibrinolytic activity associated with consumption coagulopathy, resembling a diffuse intravascular coagulation 5 -7 . A case of accidental Lonomia obliqua envenoming is described, and its implications a re discussed. The re p o rt was approved by the institutional regulatory committee.
CASEA 70 year-old, previously healthy woman developed a sudden coma. Four days before, she had started to pre s e n t hematuria. Shortly after admission, her coma was rated as Glasgow 3. Physical examination revealed several skin hemo rrhages, and gross hematuria was present. Based on information in a note left by the patient, two small hyperemic lesions were identified on the tip of her left toe. Along with the note w as the the green caterpillar (Fig 1) which was hidden inside of her slipper. CT-scan imaging re v e a l e d multiple intracerebral hemorrhages (Fig 2). She died seven days after being envenomed. Her laboratory data is summarized in the Table. DISCUSSION P resentation of the symptoms of caterpillar envenoming can generally be...
