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Clinician’s Guide to Common Arthropod Bites and Stings *
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Two other specific forms of arachnidism worth noting are lactrodectism and loxoscelism. Lactrodectism, caused by black widow spiders and related species, presents as increasing pain at the site of evenomation followed by crampy abdominal pain, sweating, incoordination, and paralysis.11 There is usually no lesion at the bite site except perhaps two small puncta. As for loxoscelism, there are two main physical manifestations from fiddleback or brown recluse spider bites. One is the necrotic cutaneous type consisting of a violaceous plaque with an associated blister, surrounding pallor due to ischemia, and lastly, surrounding erythema, all forming what is often called the “red, white, and blue sign.”11 This progresses to full-thickness necrosis and ulceration of the skin with fatty areas such as the proximal thigh and buttock becoming more widely involved (Figure 9.11). Note: these lesions need to be differentiated from methicillin-resistant Staphylococcus aureus infections as localized tissue damage is prominent as well. The second, more unusual, reaction from brown recluse spiders, called viscerocutaneous, is characterized by systemic symptoms of fever, headache, and restlessness followed by ecchymoses, jaundice, and hematuria indicating massive intravascular hemorrhage.11
Poisonous and Venomous Animals - The Physician’s View
Published in Jürg Meier, Julian White, Handbook of: Clinical Toxicology of Animal Venoms and Poisons, 2017
Necrosis due to venom, as seen in bites by recluse spiders, Loxosceles (loxoscelism), may be difficult to treat. Early surgical debridement is usually not helpful, but use of drugs such as dapsone and hyperbaric oxygen therapy have some support (see Chapter 20) 44,45. Allowing for such treatments, good wound care, including elevation in the early stages, and treatment of secondary infections are important in reducing morbidity.
Systemic loxoscelism induced warm autoimmune hemolytic anemia: clinical series and review
Published in Hematology, 2022
Brandon Calhoun, Andrew Moore, Andrew Dickey, D. Matthew Shoemaker
Envenomation by a brown recluse spider, L. reclusa, can result in systemic loxoscelism which can cause warm AIHA. The diagnosis of warm AIHA is confirmed by the direct antiglobulin/Coomb’s test. Warm AIHA can be a life-threatening disease process and should be managed urgently/emergently. Hemodynamic support with intravenous fluids and RBC transfusion is the initial step in the management of these patients. Corticosteroids are the mainstay of current management. The first-line treatment for warm AIHA is corticosteroids, which has a response rate of approximately 70–85%. Second line treatments include rituximab (response rate: 73%). Rarely patients require splenectomy (response rate: 82%) for refractory disease. Corticosteroids should be tapered over a three-month period. The patient should follow-up with a hematologist/oncologist within one week after discharge and should be evaluated with a complete blood count, comprehensive metabolic panel, reticulocyte count, LDH, and haptoglobin level. In the event of refractory or relapsed warm autoimmune hemolytic anemia, the physician should consider either rituximab or splenectomy. In addition, the patient should maintain a tapering regimen of prednisone for 4–6 weeks.
Idiopathic intracranial hypertension in confirmed case of cutaneous-hemolytic loxoscelism
Published in Clinical Toxicology, 2021
Brandon J. Ricke, Sam J. Wagner, Tony N. Rianprakaisang, Stephen L. Thornton
Envenomation of the brown recluse (Loxosceles reclusa) can cause cutaneous-hemolytic loxoscelism and this patient’s presentation was consistent with a severe brown recluse envenomation. Her skin lesion demonstrated the classic red, white, and blue sign. She developed shock, hypoxia, hemolysis, acute kidney injury, and rhabdomyolysis which have all been described with brown recluse bites [1]. This case is unique in the association of the brown recluse envenomation with the development of IIH with cranial nerve VI palsy. The etiology of IIH is unclear but maybe related to an imbalance in cerebrospinal fluid production and drainage. This results in elevated intracranial pressure, headache, and papilledema with visual loss. The mechanism by which brown recluse venom may cause IIH is uncertain but it is known to cause significant inflammation [2,3]. Systemic inflammation could result in impaired CSF drainage. Venom of other Loxosceles sp may have adverse effects on neurological tissue, including the choroid plexus, which could cause derangements in CSF production [4]. IIH has been associated with anemia from iron deficiency [5]. This patient did experience anemia from hemolysis which could be a confounder contributing to IIH. IIH is classically associated with obesity, certain drugs, and Addison’s disease.
Atypical systemic and dermatologic loxoscelism in a non-endemic region of the USA
Published in Clinical Toxicology, 2021
John W. Downs, Kevin T. Gould, Ryan C. Mclaughlin, Kirk L. Cumpston, S. Rutherfoord Rose
Loxosceles reclusa (LR), commonly known as the brown recluse spider, is endemic to specific geographic areas. Most envenomations in North America occur in the south central United States, notably within the states of Missouri, Kansas, Arkansas, and Tennessee [1,2]. Misidentification of other spiders for LR, and misidentification of other skin lesions as LR bite sites, leads to clinical confusion [3]. The most commonly described outcome of a LR bite is a dermatonecrotic skin lesion that forms locally at the site of the bite [4]. This red, white and blue lesion that heals with minimal intervention and secondary intention is commonly portrayed in photographs found in reference texts. This oversimplification of cutaneous effects can potentially lead to misdiagnosis and management of loxoscelism (LX).