Recognition and Successful Treatment of Priapism and Suspected Black Widow Spider Bite With Antivenin

Abstract

Priapism, although uncommon in preadolescent children, is considered a true emergency. Envenomation by a black widow spider bite has been reported to induce priapism as a manifestation of its toxicity. Early recognition and timely administration of antivenin have been reported to be effective in relieving priapism. Clinicians who care for children need to be aware of this unusual presentation. The diagnosis is traditionally from either direct observation of a spider bite or capture of a spider. We report a case of a previously healthy 2-year-old boy who presented with severe irritability, leg cramps, and stomach ache. The diagnosis of a likely black widow spider envenomation was made on the basis of clinical suspicion and suggestive physical findings in absence of demonstrated exposure. This case highlights the importance of early recognition and successful resolution of symptoms with administration of antivenin and supportive care.

Priapism following a juvenile Russell’s viper bite: An unusual case report

“…Here, we report an unusual case of an adolescent male suffering a priapism following a bite from a juvenile Russell's viper (Daboia russelii). The history of priapism following venomous bites is primarily limited to spiders, particularly, the Brazilian wandering spider (Phoneutria nigriventer), where injection of the venom in male mice caused a sustained priapism, frequently before death [6], although examples involving other spiders as well as various other venomous invertebrates are available [7][8][9]. To our knowledge, priapism following bites from vertebrates (specifically snakes) currently appears to be not documented in the literature.…”

Toddler with priapism as a result of redback spider latrodectism

“…It is thought to be due to the overstimulation of the parasympathetic nervous system that occurs in latrodectism. It is a type of high‐flow priapism where there is unregulated arterial blood flow, rather than low‐flow priapism where there is venous obstruction 6 . In the few case reports where priapism has been a feature, it has been non‐responsive to opioids or benzodiazepines and has instead been managed successfully with the administration of antivenom 6–8 .…”

“…However, with only limited data in this area, it is difficult to comment on the efficacy or adverse effects of antivenom in these patients. In the few case reports found, priapism was present for 6–10 h before antivenom administration 6,8 . In all cases, the patient was reviewed by a urologist who was satisfied with the resolution of priapism.…”

Clinical characteristics of patients with black widow spider bites: A report of 59 patients and single-center experience

“…[1] Therefore, patients with a suspected diagnosis should actively collect evidence and confirm the identity of bite spiders. [13][14][15] To officially confirm the diagnosis, the patient must bring in the spider after witnessing the bite and an entomologist, medical toxicologist, or another qualified specialist must identify the spider. [1] However, this is not necessary, and it is not recommended for patients to capture, harm or handle the spider.…”