Images in Emergency Medicine
Article Outline
[Ann Emerg Med. 2007;50:368.]
A 46-year-old man was working in a warehouse in southern Minnesota which receives shipments from the south-central United States. He felt something crawling under his shirt, followed by a sharp pain in his left upper back. He captured the spider pictured (Figure 1). Several hours later, he presented to the emergency department with a painful erythematous lesion with central raised ecchymosis (Figure 2) at the site of the bite. He was treated conservatively. On follow-up with his family physician at 1 week, the wound was unchanged, and a 10-day course of cephalexin was initiated. The wound resolved in approximately 3 weeks.
Figure 1.
Spider
Figure 2.
Site of bite. Used with permission of Martin E. Wolfe, MD, Department of Emergency Medicine, Mayo Clinic, Rochester, MN.
Diagnosis
Loxosceles reclusa bite
Loxosceles reclusa, commonly known as the brown recluse spider, is not native to Minnesota.1 In this case, it appears to have been inadvertently transported with a shipment from the south-central United States, where it is native. Skin wounds of other causes are commonly misdiagnosed as brown recluse spider bites.2 This case represents a rare confirmed Loxosceles reclusa envenomation outside of the spider’s normal geographic range. These bites may result in necrotic cellulitis, with the treatment primarily supportive. Specific treatments are commonly used, but strong clinical evidence is lacking and significant adverse sequelae may result from these unproven therapies.1
References
PII: S0196-0644(07)00282-X
doi:10.1016/j.annemergmed.2007.02.021
© 2007 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
