Man With Back Pain

Article Outline

• Diagnosis
  • Black widow spider bite
• Copyright

A 36-year-old man presented to the emergency department, complaining of severe back pain after a spider bite. The patient was in his house without his shirt on when he felt an insect bite to his right upper back. He described progressive onset of severe back pain during the next 2 hours that did not respond to over-the-counter medications. The patient was ill appearing, with diffuse diaphoresis, temperature of 99.7°F (37.6°C), pulse rate of 120 beats/min, respiration rate of 20 breaths/min, blood pressure of 200/110 mm Hg, and oxygen saturation of 99% on room air. On physical examination, he had a 15-cm, oval, targetlike lesion with a central erythematous bite mark in the center of a 4-cm erythematous and anhidrotic circle that was surrounded by a pale and hyperhidrotic halo (Figure 1). The hyperhidrotic halo left an impression on the sheet that the patient was resting on (Figure 2). His examination result was otherwise normal.

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• Figure 1. 

  Targetlike lesion.

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• Figure 2. 

  Hyperhidrotic halo. Used with permission of Gil Z. Shlamovitz, MD, Department of Emergency Medicine & Traumatology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT.

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Diagnosis 

Black widow spider bite 

The insect was identified as a black widow spider because the patient brought it with him to the emergency department. The patient was treated with multiple dosages of intravenous diazepam and morphine for pain control and control of his hypertension and tachycardia. He improved overnight and was discharged home in good condition, not requiring administration of antivenin.