Bites of Brown Recluse Spiders and Suspected Necrotic Arachnidism

Swanson, David L.; Vetter, Richard S.

doi:10.1056/nejmra041184

Cited by 163 publications

(106 citation statements)

References 51 publications

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“…In some cases, local dermatonecrosis or necrotic arachnidism can develop, though the true incidence of this complication is not known [2]. Systemic loxoscelism can also occur and is characterized by nausea, vomiting, headaches, fever, abdominal pain, a diffuse, reticular, erythematous rash, and in severe cases, hemolysis, coagulopathy, nephrotoxicity, and death [3].…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic Plasma Exchange for Refractory Hemolysis After Brown Recluse Spider (Loxosceles reclusa) Envenomation

et al. 2015

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Introduction The brown recluse spider (BRS) (Loxosceles reclusa) envenomation can lead to multiple complications, including hemolysis. We present a case of refractory hemolysis after a BRS bite treated with therapeutic plasma exchange (TPE). Case Report A 17-year-old female presented with fever, fatigue, and dyspnea. She was diagnosed with sepsis and received intravenous (IV) fluids, inotropic support, and antibiotics. On hospital day 1 she was noted to have skin lesion consistent with a BRS bite and developed hemolysis. Systemic loxoscelism with hemolysis was then suspected and methylprednisolone IV was initiated. She was discharged with a stable HGB on hospital day 3 on oral prednisolone. She was re-admitted 24 h later, with signs of worsening hemolysis. Methylprednisolone was restarted and she was transfused 4 units of packed red blood cells. TPE was initiated due to the refractory hemolysis. Shortly after the TPE session, her clinical and laboratory status improved. She required no further transfusions and was discharged on a steroid taper. Discussion TPE is an extra-corporeal method to remove substances from the blood by separating plasma from cellular blood components and replacing it with physiologic fluids. TPE has been used for snake envenomation but there are no reports detailing its use for BRS envenomations. Improvement was associated with TPE initiation and may have been due to removal of complement components activated by the spider venom. This report suggests that TPE could be a possible treatment modality for systemic loxoscelism with refractory hemolysis due to BRS envenomation. Further investigation is warranted.

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Section: Discussionmentioning

confidence: 99%

“…Most envenomations are thought to be self-limiting although necrotic arachnidism and systemic loxoscelism can occur [2,3]. Systemic loxoscelism can result in life-threatening hemolysis and death.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Plasma Exchange for Refractory Hemolysis After Brown Recluse Spider (Loxosceles reclusa) Envenomation

et al. 2015

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“…Very few patients report seeing the spider bite them, let alone bring the spider in to confirm its species and instead are empirically diagnosed with a brown recluse spider bite (1, 2, 7-10). However, a strong effort by physicians who are experts on spider and other arthropod bites has vehemently rejected the notion that brown recluse spiders are causing these lesions (1,2,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). They argue that spiders, by nature, are not aggressive and will not attack unless provoked and should thus always be found in one's close proximity.…”

Section: Introductionmentioning

confidence: 99%

“…They argue that spiders, by nature, are not aggressive and will not attack unless provoked and should thus always be found in one's close proximity. Furthermore, physicians have reported brown recluse spider bites across the country, but the spiders have definitively been found only in a few states in the southern and central U.S. (7). Several studies have demonstrated that the number of diagnoses of spider bites far exceeds the actual number of brown recluse spiders (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

�Bug Bite�: a case series of 11 patients referred to a single plastic surgeon

Ml¹

2017

cderm

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SummaryBrown recluse spiders have long been blamed as the cause of an acute-onset dermatonecrotic ulcerative lesion. However, research over the past fifteen years has vehemently refuted that notion and have concluded that the number of brown recluse spider bite diagnoses far exceeds the number of actual such bites. What is difficult about this problem is that the other causes of dermatonecrotic ulcerative are so rare and present with systemic symptoms, meaning that most of these "brown recluse spider bites" must actually be idiopathic acute-onset dermatonecrotic ulcerative lesions. Here, we present a case series of 11 patients referred to a single plastic surgeon in the month of July who presented with acute-onset dermatonecrotic ulcerative lesions and thinking that they were bitten by a spider. Our goal in presenting this series, as well as reviewing the literature on brown recluse spider bites, is not to refute the fact that brown recluse spider bites are the cause of such lesions but to heighten awareness of a seemingly consistent clinical presentation and course. Because such lesions do not resolve with antibiotics or conservative therapy alone, we present this case series to demonstrate that early recognition and referral for proper wound debridement and management is critical for optimal prognosis. KEY WORDS: spider bite; brown recluse spider; dermatonecrotic lesion; dermatonecrotic ulcer.

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“…[2][3][4][5] This disparity between large numbers of reported loxoscelism cases versus few verified brown recluse specimens in areas outside of their native range signifies that this condition is over diagnosed in many parts of the country. There are many alternate causes of skin lesions that have been mistaken for brown recluse spider bites, 1 including methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a rapidly emerging infectious disease threat in many parts of the United States.…”

mentioning

confidence: 99%