CASE STUDY: AN INCREASE IN BROWN RECLUSE SPIDER BITES SO BEWARE OF DARK SPACES

POSTER PRESENTATIONS

Introduction. The emergency department presentation (ED) of Brown recluse (Loxosceles reclusa) spider bites often includes local symptoms followed by severe pain and pruritus. This case had an erythematous “bulls-eye” appearance at the bite site that can cause a life threatening cytotoxic and/or hemolytic clinical complication. Renal failure, seizures, disseminated intravascular coagulopathy (DIC), coma and death can result. A delayed or missed spider bite diagnosis can lead to these severe complications. Aggressive surgical intervention with deep tissue debridement and skin grafting is often required. Case presentation. A 17-year-old female presents to the ED for evaluation of a possible spider bite to the right leg 3 days ago. Initially the bite area on her right thigh was painful, itchy and the size of a quarter. She was seen by Urgent Care that night and prescribed antibiotics. The next day the wound looked worse and the patient was admitted to pediatrics with plastic surgery consultation. Results. Despite a high morbidity rate associated with brown recluse spider bites, this patient's wound healed by secondary intention after initial debridement and aggressive wound management. Deviation From the Expected. The local wound extensive necrosis, systemic and hemolytic or renal life-threatening complications associated with these spider bites were avoided. Discussion. The treatment of this condition was by surgical debridement and wound management that resulted with improvement of the patient’s condition. Conclusion. Clinicians in an acute emergency department setting must maintain a high index of suspicion for spider bites that can present with neurological and hematologic symptoms Grants. No grants were utilized for this study.