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Cimex Lectularius (Bedbug) Bites Presenting as Chronic Urticaria

      RATIONALE: Bedbugs have undergone resurgence with increasing numbers of infestations. Bedbug bites may resemble urticarial lesions and should be considered in patients who awaken with wheals accompanied by itching and inflammation.
      METHODS: DN is a 54 year-old woman who presented with a complaint of hives for 6 months. She had hives several years earlier that resolved spontaneously. Her hives were worse at night and would interfere with her sleep. The hives would resolve over the course of the day and recur the following night. A dermatologist performed a punch biopsy that demonstrated an interstitial and perivascular mixed inflammatory infiltrate, consistent with urticaria. She was treated with clobetasol cream, permethrin for presumed scabies, and her apartment was sprayed by an exterminator. She continued to have symptoms nightly.
      RESULTS: She presented with urticarial lesions on her arms, legs and upper back along with several bedbugs that she had recovered from her bed sheets that morning. The insects were identified as Cimex lectularis. She was treated with oral antihistamines and a short course of oral corticosteroids for the lesions. Her mattress was discarded and her apartment was professionally treated specifically for bedbug infestation. Her urticarial lesions resolved and have not recurred
      CONCLUSIONS: More frequent reports of bedbug infestations in the US and worldwide should lead clinicians to consider this as a cause of urticarial lesions that occur at night.