Acute toxic fulminant myocarditis after a black widow spider envenomation: Case report and literature review

Golcuk, Yalcin; Velibey, Yalçın; Gönüllü, Hayriye; Şahin, Musa; Kocabaş, Engin

doi:10.3109/15563650.2013.774010

Cited by 12 publications

(8 citation statements)

References 4 publications

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“…The pathology of the cardiac effects related to the envenomation remain unknown for certain. It is believed that cardiac effects are induced by the activation of the adrenergic system by latrotoxin, the most dominant component of the venom (5,10). Inflammatory cell infiltrates and cytokine activation cause elevated troponin I levels that leads to myocarditis (11).…”

Section: Discussionmentioning

confidence: 99%

Black Widow Spider Envenomation with Elevated Troponin I Levels

Daş¹,

Akdur²,

Akman³

et al. 2018

J Emerg Med Case Rep

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The history of previously healthy 24-year-old male patient revealed that he had been bitten by a black spider inside his shoe while he was working in the garden. Initially, he neglected it and continued working, but soon he felt burning sensation and 55 ABSTRACT Introduction: The black widow spider is found worldwide. Alpha-latrotoxin is responsible for the toxic effects related to the spider bite. We report the case of a patient who presented at the emergency department after being bitten by a black widow spider that later developed increased cardiac enzymes. Case Report: The patient was a 24-year-old male who had been bitten by a black spider inside his shoe while he was working in the garden. The patient was referred to the emergency department of department of emergency medicine Çanakkale Onsekiz Mart University Faculty of Training and Research Hospital with nausea, vomiting, and severe rigidity in the abdomen for the differential diagnosis of acute abdomen. With severe sweating, the patient had rales in the lower lung zones, and abdominal examination revealed diffuse abdominal guarding. Blood biochemistry revealed creatine kinase (CK): 1838 U/L, CKMb: 71.6 U/L, and troponin I: 0.14 ng/mL. In follow-ups, the troponin I levels increased to 3.01 ng/mL. Electrocardiography revealed normal sinus rhythm. He was followed with a bedside monitor for 3 days in the emergency department. When the patient's troponin I and CK levels decreased, at the end of the third day he was discharged.. Conclusion: Black widow envenomation should be followed for cardiac toxicity other than symptoms, such as muscle spasms, sweating, anxiety, and headache.

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Section: Discussionmentioning

confidence: 99%

Black Widow Spider Envenomation with Elevated Troponin I Levels

Daş¹,

Akdur²,

Akman³

et al. 2018

J Emerg Med Case Rep

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“…In the literature, takotsubo cardiomyopathy has been reported after a wasp, 10 a jellyfish sting, 11 as well as following a snake bite. 12 In addition, a few case reports of acute toxic myocarditis caused by black widow spider bites exist, 13 , 14 and it seems that magnetic resonance imaging may help in its confirmation without the need of a myocardial biopsy. 15 Nevertheless there has been no report so far of a case of reverse takotsubo cardiomyopathy triggered by a spider bite as it is the case in our patient.…”

Section: Discussionmentioning

confidence: 99%

Transient Reverse Takotsubo Cardiomyopathy Following a Spider Bite in Greece

Alexakis¹,

Arapi

Stefanou³

et al. 2015

Medicine

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“…A catecholamine surge, direct toxicity, and hypersensitivity reaction are all possible mechanisms for ∝-latrotoxin that lead to myocarditis. 4,6,8,[10][11][12]14 Another possible etiology of the cTnI elevation seen in our patient is from rhabdomyolysis, another uncommon complication of black widow spider envenomation. The literature suggests that cTnI can be elevated in patients who also have an elevated total CK in a range consistent with rhabdomyolysis (CK greater than 1,000 IU/L, which (5)is four times the upper limit of normal), as seen in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…5 To our knowledge, only nine cases of myocarditis after black widow envenomation have been reported in the literature. [6][7][8][9][10][11][12][13][14] The age distribution of the reported cases ranges from 15 to 65 years old with both males and females affected. Of the nine reported cases, eight occurred in Italy, Morocco, Turkey, or Greece, and one occurred in North America.…”

Section: Discussionmentioning

confidence: 99%

Troponin elevation after black widow spider envenomation

Bush

Davy

2015

CJEM

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Black widow spider envenomation generally results in selflimiting pain that can be treated in the emergency department (ED) with analgesics and benzodiazepines, usually with no further intervention. Occasionally, a patient has to be admitted or treated with antivenom for refractory pain or a venom-induced complication. We present the case of an 84-year-old man who presented to our ED with chest pain and dyspnea after being bitten on the foot by a western black widow spider (Lactrodectus hesperus). His initial cardiac troponin I (cTnI) was elevated at 0.07 ng/ml and continued to rise to a peak of 0.17 ng/ml. He also had rhabdomyolysis, another uncommon complication of black widow envenomation. An elevated cTnI generally signifies myocardial injury and is rarely seen after black widow envenomation. We discuss the possible etiologies for an elevated cardiac biomarker, in this context, and review potentially serious complications of widow spider envenomation presenting with chest symptoms and an elevated cardiac biomarker. RÉSUMÉL'envenimement par piqûre de veuve noire entraîne généralement une douleur qui tend à disparaître spontané-ment et qui peut se traiter au service des urgences (SU) par des analgésiques et des benzodiazépines, habituellement sans autre intervention. Il arrive toutefois que des patients soient hospitalisés ou soient traités par des antivenins pour des douleurs rebelles ou pour des complications causées par le venin. Sera exposé ici le cas d'un homme de 84 ans qui a consulté au SU pour des douleurs thoraciques et de la dyspnée après une piqûre de veuve noire (Lactrodectus hesperus) au pied. Le taux de troponine I cardiaque (t. Ic) à l'arrivée s'élevait à 0,07 ng/ml et a continué d'augmenter pour atteindre un pic de 0,17 ng/ml. Le patient a également souffert de rhabdomyolyse, une autre complication peu fréquente de l'envenimement par piqûre de veuve noire. Une élévation du taux de t. Ic signe généralement une lésion myocardique, et le phénomène s'observe rarement à la suite d'un envenimement par piqûre de veuve noire. Il sera question ici des causes possibles de l'élévation du taux de biomarqueur cardiaque dans le contexte, ainsi que des complications potentiellement graves de l'envenimement par piqûre de veuve noire, qui produit des symptômes de type thoracique et une élévation du taux de biomarqueur cardiaque.

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Acute toxic fulminant myocarditis after a black widow spider envenomation: Case report and literature review

Cited by 12 publications

References 4 publications

Black Widow Spider Envenomation with Elevated Troponin I Levels

Black Widow Spider Envenomation with Elevated Troponin I Levels

Transient Reverse Takotsubo Cardiomyopathy Following a Spider Bite in Greece

Troponin elevation after black widow spider envenomation

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