Infection

, Volume 44, Issue 3, pp 383–387 | Cite as

Documented cutaneous loxoscelism in the south of France: an unrecognized condition causing delay in diagnosis

  • Emma Rubenstein
  • Pierre Emmanuel Stoebner
  • Christian Herlin
  • Catherine Lechiche
  • Christine Rollard
  • Didier Laureillard
  • Albert Sotto
Case Report

Abstract

Background

Loxoscelism is an envenomation due to a bite by spiders of the genus Loxosceles, very well known on the American continent but unrecognized in Europe.

Case report

We report the case of a 36-year-old woman, without any medical history or treatment, who went to a University Hospital in the South of France, for a painful skin lesion on the internal part of her left thigh, which appeared in the morning and developed rapidly during the day. She was directed to the infectious disease department with a diagnosis of skin infection. In spite of the antibiotics, the lesion increased, with a hemorrhagic central blister, an irregular ecchymotic center, a pale perimeter, and an extensive inflammatory and indurate oedema affecting the whole thigh. There was also a low-grade fever, chills, intense pain and a generalized scarlatiniform exanthema. The lesion was finally diagnosed as cutaneous loxoscelism, then confirmed by collection and identification of a Loxosceles rufescens spider killed by the patient the morning of the occurrence of the lesion. Following an initial symptomatic treatment, the development of a necrotic ulcer justified a delayed surgical reconstruction, after stabilization of the lesion.

Conclusions

Loxosceles bites are usually painless and rarely noticed by patients, often leading to a presumptive diagnosis. Therefore, in the case of a dermonecrotic lesion developing unfavourably with antibiotics, cutaneous loxoscelism should be one of the diagnoses to be considered.

Keywords

Spider bite Loxosceles rufescens Cutaneous loxoscelism Necrotic ulcer 

References

  1. 1.
    Isbister GK, Fan HW. Spider bite. Lancet. 2011;378:2039–47. doi:10.1016/S0140-6736(10)62230-1.CrossRefPubMedGoogle Scholar
  2. 2.
    Gremski LH, Trevisan-Silva D, Ferrer VP, et al. Recent advances in the understanding of brown spider venoms: from the biology of spiders to the molecular mechanisms of toxins. Toxicon. 2014;83:91–120. doi:10.1016/j.toxicon.2014.02.023.CrossRefPubMedGoogle Scholar
  3. 3.
    Tambourgi DV, Gonçalves-de-Andrade RM, Van den Berg CW. Loxoscelism: from basic research to the proposal of new therapies. Toxicon. 2010;56:1113–9. doi:10.1016/j.toxicon.2010.01.021.CrossRefPubMedGoogle Scholar
  4. 4.
    Natural History Museum Bern. World Spider Catalog. 2015. www.wsc.nmbe.ch. Accessed 11 Aug 2015.
  5. 5.
    Swanson DL, Vetter RS. Bites of brown recluse spiders and suspected necrotic arachnidism. N Engl J Med. 2005;352:700–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Akdeniz S, Green JA, Stoecker WV, et al. Diagnosis of loxoscelism in two Turkish patients confirmed with an enzyme-linked immunosorbent assay (ELISA) and non-invasive tissue sampling. Dermatol Online J. 2007;13:11.PubMedGoogle Scholar
  7. 7.
    Stefanidou MP, Chatzaki M, Lasithiotakis KG, et al. Necrotic arachnidism from Loxosceles rufescens harboured in Crete, Greece. J Eur Acad Dermatol Venereol. 2006;20:486–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Pernet C, Dandurand M, Meunier L, et al. Necrotic arachnidism in the south of France: two clinical cases of loxoscelism. Ann Dermatol Venereol. 2010;137:808–12. doi:10.1016/j.annder.2010.08.008.CrossRefPubMedGoogle Scholar
  9. 9.
    Hubiche T, Delaunay P, Del Giudice P. A case of loxoscelism in southern France. Am J Trop Med Hyg. 2013;88:807–8. doi:10.4269/ajtmh.12-0339.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ribuffo D, Serratore F, Famiglietti M, et al. Upper eyelid necrosis and reconstruction after spider bite: case report and review of the literature. Eur Rev Med Pharmacol Sci. 2012;16:414–7.PubMedGoogle Scholar
  11. 11.
    Swanson DL, Vetter RS. Loxoscelism. Clin Dermatol. 2006;24:213–21.CrossRefPubMedGoogle Scholar
  12. 12.
    Dyachenko P, Ziv M, Rozenman D. Epidemiological and clinical manifestations of patients hospitalized with brown recluse spider bite. J Eur Acad Dermatol Venereol. 2006;20:1121–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Delasotta LA, Orozco F, Ong A, et al. Surgical treatment of a brown recluse spider bite: a case study and literature review. J Foot Ankle Surg. 2014;53:320–3. doi:10.1053/j.jfas.2014.01.009.CrossRefPubMedGoogle Scholar
  14. 14.
    Gomez HF, Greenfield DM, Miller MJ, et al. Direct correlation between diffusion of Loxosceles reclusa venom and extent of dermal inflammation. Acad Emerg Med. 2001;8:309–14.CrossRefPubMedGoogle Scholar
  15. 15.
    Hogan CJ, Barbaro KC, Winkel K. Loxoscelism: old obstacles, new directions. Ann Emerg Med. 2004;44:608–24.CrossRefPubMedGoogle Scholar
  16. 16.
    Wright SW, Wrenn KD, Murray L, et al. Clinical presentation and outcome of brown recluse spider bite. Ann Emerg Med. 1997;30:28–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Vetter RS, Bush SP. The diagnosis of brown recluse spider bite is overused for dermonecrotic wounds of uncertain etiology. Ann Emerg Med. 2002;39:544–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Andersen RJ, Campoli J, Johar SK, et al. Suspected brown recluse envenomation: a case report and review of different treatment modalities. J Emerg Med. 2011;41:e31–7. doi:10.1016/j.jemermed.2009.08.055.CrossRefPubMedGoogle Scholar
  19. 19.
    Mold JW, Thompson DM. Management of brown recluse spider bites in primary care. J Am Board Fam Pract. 2004;17:347–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Pauli I, Puka J, Gubert IC, et al. The efficacy of antivenom in loxoscelism treatment. Toxicon. 2006;48:123–37.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Emma Rubenstein
    • 1
  • Pierre Emmanuel Stoebner
    • 2
  • Christian Herlin
    • 3
  • Catherine Lechiche
    • 1
  • Christine Rollard
    • 4
  • Didier Laureillard
    • 1
  • Albert Sotto
    • 1
  1. 1.Infectious Disease DepartmentUniversity Hospital of NîmesNîmes Cedex 09France
  2. 2.Department of DermatologyUniversity Hospital of NîmesNîmes Cedex 09France
  3. 3.Department of Plastic Surgery, Burns and Wound HealingUniversity of MontpellierMontpellierFrance
  4. 4.Institut of Systematic, Evolution and Biodiversity, UMR 7205 CNRS MNHN UPMC EPHENational Museum of Natural History of ParisParisFrance

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