Laboratory Studies

Laboratory studies are generally not required for caterpillar stings unless evidence of coagulopathy is present, as in some New World caterpillars in the family Saturniidae (Lonomia species). Those that may be warranted include the following:

Hematology: CBC
Coagulation studies: Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen level, fibrin degradation products, D-dimer assay, urine bedside test for blood
Renal function studies: Creatinine, BUN

Imaging Studies

A chest radiograph is reasonable if the patient has significant respiratory symptoms.

Treatment & Management

Estrella M, Elston DM. What's eating you? Megalopyge opercularis. Cutis. 2020 Jul. 106 (1):23-24;27. [QxMD MEDLINE Link]. [Full Text].
Lipkova B, Gajdosova E, Kacerik M, Duranova M, Izak MG. Caterpillar setae penetration in an eye: long-term follow-up. Retin Cases Brief Rep. 2013 Summer. 7 (3):252-4. [QxMD MEDLINE Link].
Sridhar MS, Ramakrishnan M. Ocular lesions caused by caterpillar hairs. Eye (Lond). 2004 May. 18 (5):540-3. [QxMD MEDLINE Link].
Rajagopalan J, Joy A, Yadalla D, Assadi FA. A Rare Hideout for Caterpillar Hairs. Ophthalmic Plast Reconstr Surg. 2020 Jul/Aug. 36 (4):e93-e94. [QxMD MEDLINE Link].
Forrester MB. Megalopyge opercularis Caterpillar Stings Reported to Texas Poison Centers. Wilderness Environ Med. 2018 Jun. 29 (2):215-220. [QxMD MEDLINE Link].
Seldeslachts A, Peigneur S, Tytgat J. Caterpillar Venom: A Health Hazard of the 21st Century. Biomedicines. 2020 May 30. 8 (6):[QxMD MEDLINE Link]. [Full Text].
Bonamonte D, Foti C, Vestita M, Angelini G. Skin Reactions to pine processionary caterpillar Thaumetopoea pityocampa Schiff. ScientificWorldJournal. 2013. 2013:867431. [QxMD MEDLINE Link].
Iacobucci G. Oak moth caterpillar that causes rash is spreading in southeast England. BMJ. 2013 May 8. 346:f2964. [QxMD MEDLINE Link].
Holland DL, Adams DP. "Puss caterpillar" envenomation: a report from North Carolina. Wilderness Environ Med. 1998 Winter. 9 (4):213-6. [QxMD MEDLINE Link].
Neustater BR, Stollman NH, Manten HD. Sting of the puss caterpillar: an unusual cause of acute abdominal pain. South Med J. 1996 Aug. 89 (8):826-7. [QxMD MEDLINE Link].
Greene SC, Carey JM. Puss Caterpillar Envenomation: Erucism Mimicking Appendicitis in a Young Child. Pediatr Emerg Care. 2020 Dec. 36 (12):e732-e734. [QxMD MEDLINE Link].
Wills PJ, Anjana M, Nitin M, Varun R, Sachidanandan P, Jacob TM, et al. Population Explosions of Tiger Moth Lead to Lepidopterism Mimicking Infectious Fever Outbreaks. PLoS One. 2016. 11 (4):e0152787. [QxMD MEDLINE Link].
DuGar B, Sterbank J, Tcheurekdjian H, Hostoffer R. Beware of the caterpillar: Anaphylaxis to the spotted tussock moth caterpillar, Lophocampa maculata. Allergy Rhinol (Providence). 2014 Jul. 5 (2):113-5. [QxMD MEDLINE Link].
Bleriot A, Couret C, Lebranchu P, Le Meur G, Weber M. [Keratitis due to foreign bodies from a processionary caterpillar nest]. J Fr Ophtalmol. 2015 Jan. 38 (1):85-6. [QxMD MEDLINE Link].
Prasad SC, Korah S. Rare Presentation of Ophthalmia Nodosa. Middle East Afr J Ophthalmol. 2015 Oct-Dec. 22 (4):520-1. [QxMD MEDLINE Link].
Casado Verrier E, Carro Rodríguez MA, de la Parte Cancho M, Piñeiro Pérez R. [Systemic reaction after pine processionary caterpillar ingestion. Conservative management?]. Arch Argent Pediatr. 2016 Jun 1. 114 (3):e151-4. [QxMD MEDLINE Link].
MacKinnon JA, Waterman G, Piastro K, Oakes J, Pauze D. Oropharyngeal Edema in an 8-Month-Old Girl after Woolly Bear Caterpillar Exposure. J Emerg Med. 2015 Nov. 49 (5):e147-9. [QxMD MEDLINE Link].
Avery E. Michienzi, Erik P. Hostage, Ryan J. Cole, Nathan P. Charlton. The Sting of a White Flannel Moth Caterpillar (Norape Ovina). Wilderness and Environmental Medicine. May 13, 2022. [QxMD MEDLINE Link]. [Full Text].
Sánchez MN, Mignone Chagas MA, Casertano SA, Cavagnaro LE, Peichoto ME. [Accidents with caterpillar Lonomia obliqua (Walker, 1855). An emerging problem]. Medicina (B Aires). 2015. 75 (5):328-33. [QxMD MEDLINE Link].
Maggi S, Faulhaber GA. Lonomia obliqua Walker (Lepidoptera: Saturniidae): hemostasis implications. Rev Assoc Med Bras. 2015 May-Jun. 61 (3):263-8. [QxMD MEDLINE Link].
Medeiros DN, Torres HC, Troster EJ. Accident involving a 2-year-old child and Lonomia obliqua venom: clinical and coagulation abnormalities. Rev Bras Hematol Hemoter. 2014 Nov-Dec. 36 (6):445-7. [QxMD MEDLINE Link].
Schmitberger PA, Fernandes TC, Santos RC, de Assis RC, Gomes AP, Siqueira PK, et al. Probable chronic renal failure caused by Lonomia caterpillar envenomation. J Venom Anim Toxins Incl Trop Dis. 2013 Jun 3. 19 (1):14. [QxMD MEDLINE Link].
Hossler EW. Caterpillars and moths. Dermatol Ther. 2009 Jul-Aug. 22(4):353-66. [QxMD MEDLINE Link].

Media Gallery

Caterpillar envenomations. Puss caterpillar or asp. Photo courtesy of the Arizona Poison and Drug Information Center.
Distinguishing dangerous from harmless caterpillars can be difficult, and handling any caterpillar with bare skin should be avoided. These are harmless tomato hornworm caterpillars (larval form of the five-spotted hawk moth [Manduca quinquemaculata])

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Author

Andrew G Park, DO, MPH, FAWM Associate Professor, Department of Emergency Medicine, Department of Preventative Medicine and Public Health, University of Kansas Medical Center

Andrew G Park, DO, MPH, FAWM is a member of the following medical societies: Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jonathan Bauman, MD Resident Physician, Department of Emergency Medicine, University of Kansas Medical Center

Jonathan Bauman, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association, Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert L Norris, MD Professor Emeritus, Department of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, Wilderness Medical Society

Disclosure: Nothing to disclose.

Samuel M Keim, MD, MS Professor and Chair, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.