Rare case of dermonecrosis caused by a recluse spider bite in Europe

Abstract

Spider poisoning is rare in Europe, with very few reported cases in the literature. Recluse spider (genus Loxosceles) bites may lead to cutaneous and systemic manifestations known as loxoscelism. We report the second known case of spider bite poisoning in Malta caused by Loxosceles rufescens (Mediterranean recluse spider). A young adult female presented with localised erythema and pain on her left thigh after a witnessed spider bite. Over a few days, the area developed features of dermonecrosis together with systemic symptoms, including fever, fatigue and a generalised erythematous eruption. She was managed by a multidisciplinary team and the systemic symptoms resolved within 6 days, while the skin lesion healed with scarring within 2 months. A recluse spider bite should be considered in patients with dermonecrosis. Although spider bite poisoning is uncommon in Europe, it is important to diagnose and manage it appropriately since it could lead to potentially serious sequelae.

Brown recluse (L. rufescens) can bite in Northern Italy, too: first case report and review of the literature

“…The lymphangitis seen in our case has also been described in the literature as a clinical presentation of spider bites, especially of the Loxosceles genus 16 17. The temporal evolution of the lesion is variable and depends on the severity 18…”

Erythema multiforme triggered by a spider bite in an adult female patient

“…The most frequently involved spiders arise from the genus Loxosceles [5]. The local lesion of the spider bite is initially painless and may easily be overlooked by the patient [6]. Lesions may be mild, moderate, or severe depending upon the presence and degree of necrosis.…”

Ultrasonography for early detection of non‐infectious necrotizing fasciitis secondary to cutaneous loxoscelism

“…1,2 Cutaneous loxoscelism (CL) is a form of spider bite poisoning, caused by necrotizing venom-producing Loxosceles spp, that typically courses with dermonecrosis. [3][4][5] In Mediterranean Europe, CL is produced by Loxosceles rufescens and is probably underdiagnosed. 3 A 50-year-old woman consulted to the emergency department for painful erythematous swelling on her forearm hours after a spider bite.…”

“…9 The L. rufescens spider is endemic on the European Mediterranean basin, where it can be found in both rural and urban areas and where it is known to produce CL. 3,5,9 Clinical presentation of CL typically occurs several hours after the bite as a necrotic plaque with black, blueish-grey, pale and violaceous hues, that progresses despite treatment. 3,5 It may also present an excentric puncture sign.…”

“…3,5,9 Clinical presentation of CL typically occurs several hours after the bite as a necrotic plaque with black, blueish-grey, pale and violaceous hues, that progresses despite treatment. 3,5 It may also present an excentric puncture sign. Our case was consistent with these clinical features.…”