Images in clinical medicine. Bedbug bites.

n engl j med 359;10 www.nejm.org september 4, 2008 1047 A 30-year-old healthy woman presented with pruritic papules on both arms and breasts. Physical examination revealed multiple erythematous papules in a partially linear pattern. The patient had stayed in a hotel the night before and, on the bedsheet, had noted several reddish-brown bloodstains and flat insects (4 to 6 mm in length), one of which she collected (inset). The insect was identified as Cimex lectularius, commonly known as the bedbug. Bedbugs frequently attack exposed areas of the skin and are attracted to humans’ high body temperature and carbon dioxide production. Cutaneous reactions to bedbug bites are characterized by erythematous or urticarial papules. Lesions observed in a linear or cluster formation are typical. The definitive diagnosis depends on identification of the bedbug. The role of bedbugs as a vector for disease transmission remains unclear. With the use of topical corticosteroids, the patient’s symptoms resolved completely within 2 days.