Loxosceles Spiders

Fatal Viscerocutaneous Brown Recluse Envenomation With Orbital Compartment Syndrome

“…Treatment should address cutaneous and symptomatic features simultaneously, including wound care, immobilization, tetanus prophylaxis, analgesics, antipruritics, antibiotics, and follow-up for delayed corrective surgery and chronic wound care management [2]. Equivocal evidence is demonstrated for dapsone use; colchicine, tetracycline, hyperbaric oxygen therapy, corticosteroids, and nitroglycerin have shown no benefit [2,3]. Ongoing vaccine trials and use of antivenom are noted in Latin America, with none indicated in the USA [2,4,8,9].…”

“…Equivocal evidence is demonstrated for dapsone use; colchicine, tetracycline, hyperbaric oxygen therapy, corticosteroids, and nitroglycerin have shown no benefit [2,3]. Ongoing vaccine trials and use of antivenom are noted in Latin America, with none indicated in the USA [2,4,8,9].…”

“…Painless or skin prick bites usually occur during sleep and while changing clothes when it is inconspicuously hidden and suddenly disturbed [2]. Locations include the leg, arm, and torso in most cases, and only 0.6-1.5% are on the face, neck, shoulder, buttocks, or genitalia [2]. The venom is hyaluronidase and cytotoxic sphingomyelinase-D venom mixture, promoting tissue penetration and necrosis with hemolysis, respectively, noting the "red, white, and blue sign" and risk for systemic involvement [1][2][3].…”

“…Locations include the leg, arm, and torso in most cases, and only 0.6-1.5% are on the face, neck, shoulder, buttocks, or genitalia [2]. The venom is hyaluronidase and cytotoxic sphingomyelinase-D venom mixture, promoting tissue penetration and necrosis with hemolysis, respectively, noting the "red, white, and blue sign" and risk for systemic involvement [1][2][3]. Through a complaint of a bite, geographical information, clinical manifestations, and laboratory evidence, the diagnosis is either putative, presumptive, probable, or documented [2].…”

“…The venom is hyaluronidase and cytotoxic sphingomyelinase-D venom mixture, promoting tissue penetration and necrosis with hemolysis, respectively, noting the "red, white, and blue sign" and risk for systemic involvement [1][2][3]. Through a complaint of a bite, geographical information, clinical manifestations, and laboratory evidence, the diagnosis is either putative, presumptive, probable, or documented [2]. We report a probable viscerocutaneous loxoscelism envenomation by a Loxosceles spider (possibly L. apachea, L. blanda, or L. reclusa) with lateral canthotomy in West Texas.…”