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A previously healthy 25-year-old nongovernmental organization volunteer in Malawi developed acute swelling of both lips and a “cold sore” on the inner aspect of the lower lip and some mild patchy erythema to his face and ears. He reported no fever or pain, but did notice some tingling of the lips and general malaise. He denied any new intimate partners, foods, or other exposures. The patient reported no history of previous symptomatic herpes simplex virus infection. His only significant medical history consisted of two episodes of poison oak dermatitis. He was begun empirically on diphenhydramine and subsequently on acyclovir without improvement.
Upon reexamination, the patient was noted to have developed cheilitis and angioedema of the face (Figure 1). The lips were edematous, eroded, and diffusely erythematous, predominantly on the left. An erythematous, nonblanching, pruritic rash with subcutaneous edema also had spread over his left face, extending up from his lips over his cheeks and nose and up to his orbits and forehead. Periorbital edema with ptosis was also apparent on the left side. He denied any tongue swelling and had no difficulty with speech, breathing, or swallowing.
Upon further questioning, the patient acknowledged using his teeth to peel a mango for each of the previous 2 days, just as he had observed local children doing when a knife was not available. Because of the progression of his symptoms despite antihistamine therapy, he was begun on prednisone with resolution of his symptoms within 48 hours.
Mango contact allergy is more common in those with a history of poison ivy and poison oak dermatitis, as these plants are closely related and mango sap contains the same uroshiol allergen. 1,2 Travel medicine specialists should be aware of this well-described phenomenon and include this warning as part of their food safety counseling for travelers to tropical and subtropical regions, in addition to the usual education about the risk of fecal-oral pathogens from unwashed fruits and vegetables.
I. T. is supported by NIH training grant T32 HD049338.
Declaration of Interests
The authors state they have no conflicts of interest to declare.