Exogenous acral pigmentation induced by coleoptera: an underdiagnosed mimic of severe disease.

Acral purpura is generally a hallmark for severe internal disease. However, exogenous pigmentation related to contact with invertebrates, can induce acral purpura-like lesions. Data regarding the beetle's ability to cause skin hyperpigmentation or purpura-like lesions are scarce. We report a case of exogenous pigmentation caused by accidental contact with a darkling beetle, clinically simulating acral purpuric lesions. The history of recent drug inhalation and abnormal autoimmunity tests made this diagnosis difficult.