ABSTRACT
The brown recluse spider (Loxosceles reclusa) is endemic to the South, West and Central Midwestern United States, and envenomation from this spider can cause cutaneous and/or systemic symptoms. We present a case of systemic loxocelism in an adolescent male resulting in three emergency department visits and two hospitalizations for a rare case of delayed hemolysis 6 days after envenomation. A 19-year-old male presented to the emergency department twice within two days after envenomation with worsening pain, subjective fever, chills, nausea and vomiting. He required a two-day hospitalization for rhabdomyolysis and acute kidney injury. The patient was discharged with improving symptoms and laboratory results on day four before returning again on day seven with worsening symptoms. He was diagnosed with hemolytic anemia on day seven and was subsequently hospitalized for six days. This case of systemic loxoscelism manifested hemolysis six days after envenomation, following an improvement in symptoms and laboratory studies. This case highlights the need for continuous monitoring and/or follow-up in cases of systemic loxocelism.
Subject(s)
Anemia, Hemolytic , Spider Bites , Spider Venoms , Animals , Male , Hemolysis , Brown Recluse Spider , Spider Bites/complications , Spider Bites/diagnosis , Spider Venoms/toxicity , Anemia, Hemolytic/chemically inducedABSTRACT
La mordedura de la araña de rincón es un motivo de consulta frecuente en los servicios de urgencia de Chile, que puede producir un cua-dro severo con manifestaciones cutáneas y sistémicas. En Chile, Loxocelles laeta se ubica principalmente desde la I a la VIII región, aunque se han reportado casos de loxocelismo en todo el país. El veneno de esta araña tiene efecto cutáneo-necrosante, hemolítico, vasculítico y coagulante. Podemos identificar 3 tipos de loxocelismo: cutáneo necrótico (80% de los casos), cutáneo edematoso (5%) y cutáneo visceral (10-15%). Este último tiene una letalidad entre 1 y 3% del total de casos de loxocelismo, la cual depende en gran parte de la precocidad de su diagnóstico y manejo oportuno. Se debe controlar cualquier tipo de loxocelismo durante las primeras 24 a 48 horas y vigilar la aparición de síntomas y signos sugerentes del cuadro visceral. No existe ningún examen de laboratorio que confirme el diagnóstico, los cuales sólo se alteran de modo marcado en los casos viscerales. El manejo de las lesiones cutáneas es con hielo local, antiinflamatorios, antihistamínicos y curaciones seriadas. En caso del loxocelismo visceral, el tratamiento principal es de soporte. La dapsona fue una indicación frecuente en el pasado y se asocia a efectos adversos graves, siendo el principal la exacerbación de la hemólisis, por lo que actualmente su uso no está recomendado. El suero anti-loxoceles no tiene evidencia que avale menor severidad ni mortalidad del cuadro.
The bite of the corner spider is a frequent reason for consultation in the emergency services of Chile, which can produce a severe reaction with cutaneous and systemic manifestations. In Chile, Loxocelles laeta is located mainly in the first to the eighth region, but cases of loxoscelism are reported throughout the country. The venom of this spider has cutaneous-necrotizing, hemolytic, vasculitic, and coagulant effects. Three types of loxoscelism can be identified, necrotic cutaneous (80% of cases), edematous cutaneous (5%), and visceral cutaneous (10-15%). The latter has a lethality between 1 and 3% of all cases of loxoscelism, which largely depends on the early diagnosis and timely management. Any loxoscelism should be controlled during the first 24 to 48 hours, and be alert to the appearance of symptoms and signs suggestive of visceral manifestations. There isn Ìt any laboratory test to confirm the diagnosis. Laboratory tests are only markedly altered in visceral cases. The management of skin lesions is with local ice, NSAIDs, antihistamine and serial dressings. In the case of visceral loxoscelism, treatment begins with suspicion and early diagnosis. For these patients, the principal treatment is supportive care. Although it was recommended in the past, Dapsone is associated with severe adverse effects, like exacerbation of he-molysis, so its use is not currently recommended. The anti-loxocelles serum has no evidence to support less severity or mortality reduction.
ABSTRACT
INTRODUCTION: Spiders, especially those of the genus Loxoceles such as L. rufescens, endemic in Mediterranean regions, are frequently reported as causes of venom poisoning in humans in the south of France. The most common signs consist of cutaneous necrosis presenting initially as inflammatory cellulitis and progressing towards the emergence of a necrotic centre. PATIENTS AND METHODS: We report 4 cases, initially considered as spider bites due to their sudden occurrence and pain. Rigorous clinical examination coupled with collection of samples for laboratory analysis ultimately enabled the diagnosis to be corrected to one of suppurative skin infection caused by Staphylococcusaureus producing the cytotoxin Panton Valentine leucocidin. DISCUSSION: These observations highlight the potential for confusion between spider bites and infections with PVL-producing S. aureus.
