Suspected Brown Recluse Envenomation: A Case Report and Review of Different Treatment Modalities

Andersen, Rebecca J.; Campoli, Jennifer; Johar, Sandeep; Schumacher, Katherine A.; Allison, E Jackson

doi:10.1016/j.jemermed.2009.08.055

Cited by 36 publications

(38 citation statements)

References 20 publications

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“…Symptoms of systemic loxoscelism typically appear 2–3 days after the initial bite and may include high fever, malaise, myalgias, arthralgias, generalised non-specific rashes, nausea and vomiting, and possibly thrombocytopenia, haemolysis, disseminated intravascular coagulation and renal failure 18. The severity of loxoscelism depends on a number of factors.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 99%

“…Other treatments, including hyperbaric oxygen, nitroglycerin and antivenom, have been studied in animal models; however, none of these treatments has been shown to be clinically effective 3 18…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Other therapies including steroids, dapsone, and hyperbaric oxygen have not shown definitive benefit and are not recommended. 12,13 In conclusion, brown recluse envenomation can rarely result in multiple, successive cutaneous necrotic lesions. Within endemic areas, the diagnosis of cutaneous loxoscelism should be considered in such cases after excluding other etiologies.…”

Section: Discussionmentioning

confidence: 89%

Two Successive Necrotic Lesions Secondary to Presumed Loxosceles Envenomation

Tarullo

Jacobsen

Algren

2013

Wilderness & Environmental Medicine

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Brown recluse spider (Loxosceles reclusa) envenomations with subsequent necrotic skin lesions occur infrequently, and systemic loxoscelism is rarer still. We report a case of 2 successive developing necrotic lesions, each on adjacent medial aspects of the legs, secondary to presumed Loxosceles envenomation. A 31-year-old man with no significant past medical history presented to the emergency department with 2, large, necrotic lesions, 1 on each medial thigh. They had progressed over the course of 1 month from small blisters to large necrotic lesions with eschar. He underwent surgical debridement without skin grafting with no further complications. Bites from recluse spiders that progress to necrosis usually present as single lesions. The differential diagnoses for a necrotic skin lesion is large. The presence of more than 1 lesion argues against Loxosceles envenomation; however, in the absence of underlying infection, systemic diseases, immunodeficiency, or malignancy, the diagnosis must be considered if the case presents in an endemic area. Brown recluse spiders rarely bite multiple times, thus confounding the diagnosis of an already nonspecific clinical finding.

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“…Treatment of systemic loxoscelism is mainly supportive. [9] Steroids have been used to prevent kidney failure and hemolysis, but their efficacy is subject to debate. [9, 31] Other treatments that may be considered are dapsone, hyperbaric oxygen, and surgical excision.…”

Section: Discussionmentioning

confidence: 99%

“…[8] Use of dapsone, once considered a treatment for systemic loxoscelism, has declined due to the suggestion of increased risk of hemolysis. [9] The underlying pathogenesis of systemic loxoscelism remains incompletely understood, but sphingomyelinase D, a component of the venom toxin, has been shown to have a central role in the process. [10–12] Recent literature suggests it causes both direct toxin-mediated hemolysis and complement-mediated erythrocyte destruction.…”

Section: Introductionmentioning

confidence: 99%

Defining the complex phenotype of severe systemic loxoscelism using a large electronic health record cohort

et al. 2017

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ObjectiveSystemic loxoscelism is a rare illness resulting from the bite of the recluse spider and, in its most severe form, can lead to widespread hemolysis, coagulopathy, and death. We aim to describe the clinical features and outcomes of the largest known cohort of individuals with moderate to severe loxoscelism.MethodsWe performed a retrospective, cross sectional study from January 1, 1995, to December 31, 2015, at a tertiary-care academic medical center, to determine individuals with clinical records consistent with moderate to severe loxoscelism. Age-, sex-, and race-matched controls were compared. Demographics, clinical characteristics, laboratory measures, and outcomes of individuals with loxoscelism are described. Case and control groups were compared with descriptive statistics and phenome-wide association study (PheWAS).ResultsDuring the time period, 57 individuals were identified as having moderate to severe loxoscelism. Of these, only 33% had an antecedent spider bite documented. Median age of individuals diagnosed with moderate to severe loxoscelism was 14 years old (IQR 9.0–24.0 years). PheWAS confirmed associations of systemic loxoscelism with 29 other phenotypes, e.g., rash, hemolytic anemia, and sepsis. Hemoglobin level dropped an average of 3.1 g/dL over an average of 2.0 days (IQR 2.0–6.0). Lactate dehydrogenase and total bilirubin levels were on average over two times their upper limit of normal values. Eighteen individuals of 32 tested had a positive direct antiglobulin (Coombs’) test. Mortality was 3.5% (2/57 individuals).ConclusionSystemic loxoscelism is a rare but devastating process with only a minority of patients recalling the toxic exposure; hemolysis reaches a peak at 2 days after admission, with some cases taking more than a week before recovery. In endemic areas, suspicion for systemic loxoscelism should be high in individuals, especially children and younger adults, presenting with a cutaneous ulcer and hemolysis or coagulopathy, even in the absence of a bite exposure history.

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Suspected Brown Recluse Envenomation: A Case Report and Review of Different Treatment Modalities

Abstract: This is an endemic cause of a necrotizing wound bite in areas of the Midwestern and Southern United States, but it is rarely reported in the Northeast.

Cited by 36 publications

References 20 publications

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

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

Two Successive Necrotic Lesions Secondary to Presumed Loxosceles Envenomation

Defining the complex phenotype of severe systemic loxoscelism using a large electronic health record cohort

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