Rapidly progressive, fatal sequelae of brown recluse spider bite: case report

October 17, 2012, 9:16 pm

Loxosceles reclusa

★★★☆☆

Emergency Department Death From Systemic Loxoscelism. Rosen JL et al. Ann Emerg Med 2012;60:439-441.

Abstract

This unusual, dramatic case report — from the Vanderbilt University Medical Center in Nashville — describes a fatality form apparent systemic loxoscelism in a young child. This 3-year-old girl was bitten on the right chest by a spider the grandmother identified as a small brown “fiddle-back” (Loxosceles reclusa). Within 12 hours the child developed nausea, vomiting, and a dark “tea colored” urine.

Fifteen hours after the reported bite, the child was febrile and tachycardic. Laboratory evaluation showed leukocystosis (WBC 20,700/μL), anemic (hemoglobin 9.5 g/dL), and thrombocytopenic (54,00/μL). Peripheral blood smear showed spherocytes, consistent with hemolytic anemia.

Because of hemolytic anemia, the patient received a transfusion of packed red blood cells. However, during this she became apneic and pulseless, and could not be resuscitated. She was pronounced dead 19 hours after the initial injury. Investigation did not find evidence of any transfusion reaction.

The authors note that systemic loxoscelism presents with conditional symptoms including fever, nausea, vomiting, and arthralgias. In severe cases, hemolysis, renal failure and coagulopathy supervene. Although onset of systemic reaction usually occurs 2 days or more after the spider bite, the early onset — within 6 hours — and rapid progression in this case may have been due to the child’s young age.

The authors recommend that well-appearing patients with apparent L. recluse bites be tested for hematuria, and that symptomatic patients should have hemolysis, renal failure, and disseminated intravascular coagulopathy ruled-out.

Very interesting case that would have been stronger had the identification of the spider been more secure.

[Photograph of brown recluse spider from wikipedia.org]

 

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