LAUSR

A 23-year-old man reported that his pet Vietnamese centipede (Scolopendra subspinipes) escaped from its enclosure and stung him on his left ring finger near the distal interphalangeal joint when he captured it. In the emergency department, approximately 2 hours after the envenomation, his swelling involved the finger and hand (Figure 1, top left). He also had paresthesias in the fingertips. He received oral ibuprofen and remained in the observation unit overnight. The next morning (about 12 hours after the envenomation), he had swelling, erythema, and urticaria, which extended up his entire affected arm (Figure 1, bottom left & right). His pain improved but itching became his primary complaint. Later in the afternoon, he developed an urticarial rash in his contralateral axilla and flexor crease of the elbow in the contralateral arm. He received oral diphenhydramine and IV methylprednisolone. He never developed systemic symptoms of anaphylaxis. After approximately 22 hours of observation in the ED, he felt improved and was discharged with an oral prednisone taper. He declined follow up in one week because he was feeling better. At the time of preparation, the fate of his centipedes was unknown. Known by various common names, S. subspinipes is native to Southeast Asia. In the United States, S. subspinipes is endemic to the islands of Hawaii, and is available as legal pets in many states. These centipedes have a highly developed apparatus known as their forecipules for envenomation. This apparatus is separate from the mouth, so technically envenomations are stings and not bites. The rest of the centipede’s legs entrap its prey while the envenomation takes