Photoclinic: Brown recluse spider bite

Two days after cleaning her attic, a 45-year-old woman presented with several very tender ulcers on her lower mid-abdomen, low-grade fever, and headache. The patient had noticed a single papule and surrounding erythema on her abdomen a few hours after cleaning. Subsequently, bullae with grayish discoloration and pain developed. She recalled seeing a few spiders in her attic but had ignored them. Her medical history included a cholecystectomy and a resection, 4 years earlier, of a benign ovarian tumor. She takes no medications and has no drug allergies. Benjamin Barankin, MD, of Edmonton, Alberta, suspected a reaction to the bite of a brown recluse spider (Loxosceles reclusus)—commonly known as the fiddleback or violin spider, because of the distinguishing mark on its cephalothorax and the dull yellow-brown color of the body. These spiders prefer dark, dry, and undisturbed locations. They are most common in the south central United States; the highest incidence of brown recluse spider bites is reported in the summer.1 The reaction begins with the development of an eschar at the bite site, which is followed by tissue necrosis and skin sloughing. Bite reactions can include fever, malaise, headache, arthralgia, nausea with vomiting, and hematologic disorders. When the history is less obvious, a complete blood cell count and urinalysis, as well as a skin biopsy, can be helpful. Most bite wounds heal within 2 to 3 months without treatment. Symptoms can be treated conservatively with cold compresses, mild analgesics, elevation of an affected limb, and cleansing of the bite site. Rarely, surgery and systemic corticosteroids may be required. REFERENCE: 1. Wendell RP. Brown recluse spiders: a review to help guide physicians in nonendemic areas. South Med J. 2003;96:486-490.