Skin Necrosis, Diffuse Urticaria, and Cellulitis Due to Presumed Loxosceles Spider Bite

Abstract

The clinical manifestations of a recluse spider bite range from local erythema to necrotic skin reactions; bites rarely lead to a systemic disease known as viscerocutaneous loxoscelism. A 29-y-old female patient was admitted to the emergency department with a wound, swelling, and pain on her left leg and a rash on her whole body as a result of a spider bite. On physical examination, a round, hard, black, irregularly shaped necrotic area was found in the bite zone on the lower posterior part of the left thigh, as were lesions in the form of erythematous papules around the area. There was a color change around the lesion, extending from posterior to medial of the thigh, and a papule on a diffuse erythematous surface on the trunk and arms. At follow-up, the necrotic area had become more apparent. After approximately 1 mo, the necrotic area was surgically debrided and a flap was formed on the necrotic tissue area. In this article, a case that was thought to be caused by a Loxosceles spider bite and which started with erythema, progressed to lymphangitis, cellulitis, and severe necrosis, and was surgically debrided, was evaluated in light of the clinical findings and previously reported cases of verified loxoscelism. In patients with a history suggestive of a bite and with these clinical findings, the diagnosis of a bite by Loxosceles spp. should be carefully considered based on clinical and epidemiologic findings.

Integrative taxonomy reveals first record of Loxosceles rufescens (Dufour, 1820) (Araneae, Sicariidae) in the Philippines

“…Their bites can cause local erythema and necrotic skin reactions. In rare cases, it can lead to “loxoscelism”, a disease that causes myalgia, arthralgia, haemolysis, haemoglobinuria, acute renal failure and amputation and, very rarely, death (Vetter 2008, Bajin et al 2011 , Köse et al 2021 ).…”

Lymphedema as Consequence of Loxosceles Brown Spider Bite: A Case Report and Literature Review

“…Fernandez et.al [40] reported in 2018 a very severe case of loxoscelism and complications in the arm of an elderly patient; it was necessary, at first, a partial amputation of the arm and later a shoulder disarticulation. This was the patient with the longest follow-up at 10 months.…”

“…Date Study Patient characteristics Initial signs/ and symptoms Tracking time Clinical outcome Fernandez E, et. al [40]…”

Manejo quirúrgico versus tratamiento médico en loxoscelismo cutáneo: revisión sistemática y actualización

“…La araña reclusa parda o marrón, también conocida como araña violinista, pertenece al género Loxosceles. 1 A pesar de la existencia de más de 42,000 especies de arañas en el mundo, 2 sólo unas pocas son capaces de producir cuadros severos de envenenamiento en el hombre, 3 entre ellas 33 especies de Loxosceles en México. 4,5 Su mordida produce el loxoscelismo, derivado del veneno con características necrosantes hemolíticas, vasculíticas y coagulantes; 6 provoca condiciones clínicas que pueden presentarse como un cuadro de loxoscelismo cutáneo localizado o loxoscelismo sistémico, menos frecuente y más severo.…”