Millipede accident: a differential diagnosis of cyanotic lesion on the toes

Dear Editor, Millipedes, popularly known as "gongolos," are arthropods belonging to the class Diplopoda.As a defense mechanism, they secrete toxins that cause irritation and discoloration on contact with the skin 1 .The resulting lesion often has a violaceous, necrotic appearance, which may resemble tissue ischemia, making clinical differentiation challenging 2 .We report a typical case of a lesion caused by contact with millipedes and highlight an unusual differential diagnosis that may mimic vascular compromise.A 56-year-old patient, with no previous medical history, native of Rio de Janeiro, Brazil, sought medical attention for a violaceous lesion on the right hallux, with 2 days of evolution, which appeared after wearing her usual footwear.She reported the presence of an arthropod inside the shoe.Physical examination revealed an erythematous-violaceous macule on the distal phalanx of the hallux, without pain or other associated symptoms (Fig. 1).Extremities were warm, peripheral pulses and capillary refill time were normal.Histopathological examination revealed no evidence of vascular compromise or melanotic hyperpigmentation (Fig. 2).There was complete resolution of the lesion in 60 days after expectant management.Millipedes have segmented bodies, each with two pairs of legs and inhabit dark, humid environments.There are over 12,000 known species, Rhinocricus