Case report: Autochthonous Cutaneous Loxoscelism with Oedematous Predominance (CLEP) in Madrid, Spain / Caso clínico: loxoscelismo autóctono cutáneo con predominancia edematosa (CLEP) en Madrid, España

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A life-threatening situation due to a spider bite : a non-infectious necrotizing fasciitis.

We present the case of a healthy patient who sustained a spiderbite in the elbow and developed a non-infectious necrotizing fasciitis in the affected limb. Female patient aged 24 pain reported a spiderbite received some 72 h previously in Mexico (the spider was identified as a brown recluse spider-Loxosceles reclusa). Under the suspected diagnosis of necrotizing fasciitis urgent surgery was indicated. During her hospital stay, the patient required three additional surgical procedures, and was discharged from hospital 30 days after admission. Spider bites in the limb may be limb-threatening and life-threatening. Emergency doctors should be aware of this possibility, because spiders can be unintentionally transported all over the world.

Surgical treatment of a brown recluse spider bite: a case study and literature review.

Spider bite envenomation can cause local, constitutional, and/or systemic symptoms. The present case study reports on 5 years of follow-up for a "probable" brown recluse spider bite of the foot and ankle that was refractory to conservative treatment and was subsequently treated with surgery. The present case study reports the atypical occurrence of long-term peripheral neuropathy after necrotic arachnidism induced by "probable" brown recluse (Loxosceles recluse) envenomation, in a 46-year-old male. The state of published data suggests to minimize inflammation and tissue necrosis, prevent bacterial superinfection, and control pain levels. For patients with long-term peripheral neuropathy refractory to conservative therapy, surgical intervention may further improve their symptoms.

Upper eyelid necrosis and reconstruction after spider byte: case report and review of the literature.

Spider bites are not very common, especially in the Mediterranean area, and those affecting the ocular-palpebral region involving reconstructive surgery are particularly rare. In May 2010, the case of a Caucasian 24-year-old female patient was brought to the attention of the Dermatology Department, University of Cagliari, Italy. The patient reported she woke up feeling an intense pain with itching and that also she had noticed a spider of an unknown species on her bed. The dermatosis had affected the right orbital region, where there was a considerable red and violet erythema and a hard edema, not foldable. When the necrosis appeared the patient was treated at the Plastic Surgery Unit where she underwent a reconstruction of the eyelid with a full thickness skin graft from the retroauricular area. The post-operative course was regular with a perfect in-take of the skin graft. When the patient was discharged she was sent to an Entomological University Centre to identify the spider species and the possible venom which caused the skin lesion. The spider which caused the injury has been a Loxosceles rufescens (Dufour, 1820). Loxoscelism is a necrotic arachnoidism caused by the poisonous bite of spiders belonging to the Loxosceles species. It is very important to identify what sort of lesion it is and to treat it in a combined way in order to choose the proper timing for surgery to avoid damages to the eyelid functioning.

Uso de terapia VAC(R) para tratamiento de heridas por mordedura de araña reclusa café / Vacuum-Assisted Closure therapy(R) for treatment of brown recluse spider bite

Las mordeduras producidas por la araña reclusa café pueden causar una ulcera necrótica de crecimiento progresivo, tradicionalmente tratada en forma expectante, con antinflamatorios y con cirugía reconstructiva tardía. En este trabajo presentamos 2 casos clínicos tratados de forma exitosa por medio del dispositivo para el cierre asistido por presión negativa (VAC ®). Creemos que este dispositivo es un elemento importante para el manejo de esta patología, ya que la terapia por presión negativa ayuda a limitar la necrosis cutánea y a disminuir el tamaño de la ulcera y por lo tanto, acelera el proceso de recuperación del paciente (AU)

The brown recluse spider bite can cause an enlarging necrotic skin wound, traditionally treated with expectant management, anti-inflammatory drugs and late reconstructive surgery. In this paper we report 2 cases where we used Vacuum-Assisted Closure therapy (VAC®) for the successful management of these wounds. We believe that VAC® therapy is very effective in reducing wound size and skin necrosis, and also in accelerating patient recovery time (AU)

Complications and outcomes of brown recluse spider bites in children.

Brown recluse spider bites may cause severe local and systemic morbidity, but data regarding morbidity in children are limited. This study reviewed inpatient medical records (n = 26; 10 years) with a discharge diagnosis of "spider bite" from a tertiary pediatric hospital. The majority (85%) of children had an inflammatory response accompanying necrosis, usually with signs of secondary cellulitis (77%). Hemolytic anemia (50%), rhabdomyolysis (27%), and acute renal failure (12%) were the most prevalent systemic effects. Hemolytic anemia was bimodal in distribution relative to the time-of-onset of the bite (early, 2.2 ± 0.4; late, 6.9 ± 1.5 days postbite, respectively; P = .004). Although no fatalities occurred in the population, 65% of children had major morbidity, including wound complications requiring surgical care and acute orbital compartment syndrome. The findings emphasize the importance of anticipatory patient/family education for outpatients and careful monitoring for systemic morbidity in inpatients. Timely and appropriate supportive care should yield favorable outcomes in most cases.

[Necrotic arachnidism in the south of France: two clinical cases of loxoscelism]. / Envenimation nécrotique dans le Sud de la France : deux observations de loxoscélisme cutané

BACKGROUND: loxosceles spiders are found throughout the world and are responsible for numerous cases of envenomation in America and Southern Europe. We describe, to our knowledge for the first time in France, two clinical cases of cutaneous loxoscelism. CASE REPORT: two cases of skin necrosis arising after supposed spider bites were grouped together because of their similar clinical presentation: an initial painless bite and rapid development of an inflammatory and painful cutaneous lesion with a central hemorrhagic bulla surrounded by a perimeter of blanched skin (the "red, white, and blue" sign). The outcome in both cases was deep skin necrosis and chronic ulceration requiring surgical treatment. DISCUSSION: loxoscelism can result in dermonecrosis. Although our cases were not documented by capture of the spider, the diagnosis of cutaneous loxoscelism was supported by the characteristic appearance of the lesion, a typical clinical course, elimination of differential diagnoses, and the confirmed presence of Loxosceles rufescens in the region. CONCLUSION: loxoscelism can occur in the south of France and although rare, must be considered in this region as a possible cause of skin necrosis.

Síndrome compartamental de extremidad superior: experiencia con el uso de un sistema aspirativo contínuo para el manejo de una herida mayor / Compartmental syndrome of upper extremity

Presentamos a un menor de 9 años de edad quien a raíz de una mordedura de araña de rincón en su extremidad superior derecha (antebrazo) desarrolló un cuadro grave de loxoscelismo cutáneo-visceral rápidamente progresivo, que lo llevó a una insuficiencia renal aguda, además de un síndrome compartamental de la extremidad afectada, donde fue necesario efectuar una fasciotomía de descarga amplia, y varios aseos quirúrgicos con resecciones de tejido necrótico, que dejó una lesión cruenta mayor, la que fue tratada con una curación hermética aspirativa, para finalmente realizar un injerto dermoepidérmico, logrando su recuperación después de 19 días en unidad de cuidados intermedios y de 24 días totales de hospitalización, egresando sin complicaciones precoces.

Local cutaneous arachnidism: a report of three cases and their management.

Bites from Loxosceles spiders can cause few symptoms to gangrenous skin necrosis or even death. To date, the treatment of the violin spider bite is largely unsatisfactory. Although no specific therapy exists, it has been suggested that heparin, steroids, dapsone, experimental antivenin and/or surgical excision may be beneficial. Three rare cases of suspected spider bite and their surgical treatment are reported. On the basis of geographical area, anamnesis and clinical symptoms, we suppose Loxoceles rufescens responsible for these bites.

[Total upper lip necrosis and loxoscelism caused by violin spider bite]. / Pókcsípés okozta loxoscelizmus nagykiterjedésu felso ajak nekrózissal.

Arthropods and in particular spiders are a common embodiment of our fears, despite the fact that only a few species are dangerous to man. The authors present a case involving severe local and general reactions to a loxosceles (brown recluse spider) bite. They give an overview of the occurrence of loxosceles spiders, the signs and symptoms of envenomation and the therapeutic possibilities. The severe symptoms presenting following loxosceles envenomation is termed loxoscelism. Loxoscelism is characterised by local soft tissue necrosis of varying degree at the site of the sting, and rarely, life-threatening general reactions, such as haemolysis with ensuing anaemia, and renal failure. Therapeutic interventions following loxosceles bites range from dapsone treatment to hyperbaric oxygen therapy, but the most promising therapy is the use of the antiserum, commercially available in certain South-American countries where loxosceles bites are common. Treatment of soft tissue necrosis consists of necrectomy and surgical reconstruction following the resolution of the inflammatory symptoms.

Idiopathic necrotizing dermatitis: current management.

OBJECTIVES: To identify and demonstrate necrotizing dermatitis in infancy; an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation; and in particular on the speculative role of the Australian White-tailed spider, Lampona cylindrata. METHODS: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. RESULT: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine creme. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White-tailed spider, Lampona cylindrata, does not occur in Queensland, but Lampona murina does; neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. CONCLUSION: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites.

Clinical course of a loxosceles spider bite in Turkey.

We report the first case from Turkey of a dermonecrotic wound associated with possible Loxosceles spider bite and offer the complete clinical course that resulted in a permanent scar. Emergency physicians in western Turkey should be aware of Loxosceles spider bites as a cause of necrotizing wounds.

Lesiones por Picadura de Araña. Presentación de dos Casos y Revisión del Manejo Terapéutico / Spider Bit lesions. Report of two Cases and Treatment Review

Las picaduras de araña sin trascendencia clínica son frecuentes, manifestándose en forma de eritema, edema local y dolor. Generah11ente los pacientes no identifican a la araña en el momento de la lesión. El término loxoscelismo hace referencia a las lesiones locales dedermonecrosis y las manifestaciones generales (hemólisis, fallo renal agudo, coagulación .intravascular diseminada) producidas por la picadura de un tipo de araña doméstica, la Loxosceles reclusa. Se presentan dos casos clínicos de pacientes que sufrieron una picadura de araña común, desarrollando posteriormente necrosis cutánea de rápida evolución que requirió tratamiento quirúrgico. Analizamos la fisiopatología y los mecanismos implicados en este tipo de lesiones y efectuamos una revisión y puesta al día del manejo terapéutico de las mismas (AU)

Most spider bites involving humans cause minimal medica! problems and result in erythema, local edema and pain. Patients infrcquently present with a positive identification after potential envenomation. Loxoscelism is used to describe dermonecrosis lesions and general reactions (haemolysis, acure renal failure, disseminated intravascular coagulation) induced by domestic spiders bite (Loxosceles reclusa). Two cases of spiders bite that develop a fast dermonecrosis and need surgical treatment are reported. We analized the fisiopathology and mecanism of these kind of Iession and present a treatment review (AU)

Clinical presentation and outcome of brown recluse spider bite.

STUDY OBJECTIVE: To examine the clinical presentation and outcome of patients treated in the ED or toxicology clinic for suspected brown recluse spider bites. METHODS: We assembled a retrospective case of patients at a southeastern US university hospital. Our study group comprised 111 patients with suspected brown recluse spider bites treated during a 30-month period. Our main outcome measures were the need for skin grafting and the development of other complications. RESULTS: The mean age of our subjects was 34 +/- 17 years. Thirteen patients (12%) brought the spider to the hospital, 22 (20%) saw a spider at the time of the bite, and an exclusively clinical diagnosis was made in the remaining 76 (68%). Most wounds (59%) involved the leg. At the time of presentation, 81% had central discoloration and 37% necrosis. Sixteen patients (14%) were systemically ill, and 6 (5%) were admitted to the hospital. Most (86%) were treated with antibiotics. Dapsone was infrequently used (9%) and had usually been prescribed before the patient's presentation to our ED. Only three patients (3%; 95% confidence interval, 1% to 8%) required grafting. Mild hemolytic anemia developed in one patient, and another had mild hemolysis and a mild coagulopathy; neither patient was taking dapsone. No deaths or serious complications occurred in our study group. CONCLUSION: In our series, long-term outcome after brown recluse spider bite was good. Serious complications were rare, as was the need for skin grafting. Because the vast majority of bites heal with supportive care alone, aggressive medical therapy does not appear warranted.

Pseudoepitheliomatous hyperplasia and pyoderma gangrenosum after a brown recluse spider bite.

Brown recluse spider bites may result in extensive soft tissue injury, causing months of disability. We have described a patient who had a series of extensive surgical debridements after envenomation. Despite skin grafting, persistent cutaneous lesions and extensive satellitosis progressed to involve the entire lower extremity. A recent biopsy showed pseudoepitheliomatous hyperplasia and pyoderma gangrenosum complicating the original injury. Although the role of early surgical excision and newer forms of medical treatment including dapsone and antivenom are still in evolution, recent reports suggest that the majority of patients will respond to medical therapy and may not require any surgical intervention.

Management of the brown recluse spider bite.

The objectives in the treatment of the brown recluse spider bite are to prevent skin necrosis and the need for reconstructive surgery. A simple technique that consists of curetting the subcutaneous tissue in the necrotic area of the lesion, to prevent the local destructive actions of the toxin, is described. From 1981 to 1987, 18 patients were treated with this technique. The wounds were generally curetted under local anesthesia in an outpatient setting. In all but one case, the erythema, edema, and pain resolved significantly in 24 to 48 hours, and the wounds healed primarily with minimal scarring. We consider curettage the treatment of choice for brown recluse spider bites when the lesions are noted in relatively early stages. It can be performed as an outpatient procedure; it controls the symptoms and prevents further necrosis, with excellent cosmetic results.