Case report: dapsone hypersensitivity syndrome associated with treatment of the bite of a brown recluse spider

Dapsone (4-4-diaminodiphenyl-sulfone) is a member of the sulfone group of antibiotics used in the treatment of leprosy and various dermatitidies and more recently employed in the management of local reactions to the bite of the brown recluse spider, Loxosceles reclusa. A dapsone hypersensitivity syndrome, consisting of fever, headache, nausea, vomiting, lymphadenopathy, hepatitis, hemolysis, leukopenia, and mononucleosis, has been described in patients treated with the drug for leprosy. A case report of the hypersensitivity syndrome occurring in a patient being treated with dapsone for a brown recluse spider bite is presented.     

Lyme disease masquerading as brown recluse spider bite

We report a case of Lyme disease with clinical features resembling those described from brown recluse spider bites. The most striking manifestation was a necrotic skin wound. Brown recluse spider bites may be overdiagnosed in some geographic regions. Tick bite and infection with Borrelia burgdorferi should be considered in the differential diagnosis of necrotic arachnidism in regions endemic for Lyme disease.     

Spider (Latrodectus hesperus) poisoning through the conjunctiva. A case report

Spider poisoning is usually a result of the direct bite, envenomation through the chelicera, of the spider. Reported is an unusual case in which poisoning occurred through the conjunctiva when a fragment from a smashed black widow spider (Latrodectus hesperus) flew into a patient's eye. In addition to an immediate local reaction involving the periorbital tissues, the patient experienced systemic effects.     

Transient Reverse Takotsubo Cardiomyopathy Following a Spider Bite in Greece: A Case Report

Black widow spider is endemic in the Mediterranean area and although envenomations are rare, may occasionally lead to death.We present a case of a 64-year-old female developing a rare variant of takotsubo, stress-induced, cardiomyopathy after a spider bite. This resulted in acute heart failure within 24 hours of the bite. With medical treatment and supportive care, the patient''s clinical condition improved.Reverse takotsubo cardiomyopathy was diagnosed by echocardiography, which was transient. Clinical and echocardiographic findings have been completely resolved on follow-up 46 days later.Reverse takotsubo cardiomyopathy has not been yet described following a spider bite. Doctors in the emergency department of endemic countries should be familiar with this potential complication.     

Emergency department death from systemic loxoscelism

Systemic loxoscelism is a constitutional illness resulting from the bite of the brown recluse spider. In severe form, it may cause hemolysis, acute renal failure, and disseminated intravascular coagulation. More rarely, it may result in death. We report an unusual case of systemic loxoscelism resulting in death less than one day following envenomation. We also discuss screening algorithms and contemporary management of systemic loxoscelism.     

Brown recluse spider bites: a complex problem wound. A brief review and case study

Brown recluse spiders (Loxosceles reclusa) are responsible for virtually all documented cases of spider bites leading to significant necrosis. The actual spider bite often goes unnoticed for as long as 4 to 6 hours, which makes diagnosis and, therefore, appropriate treatment, difficult. The spider bite generally results in either a necrotic wound or systemic symptoms that can lead to hemolysis. The patient described in this article experienced both complications. Dapsone and hyperbaric oxygen therapy brought the adverse response to the bite under control. The patient was hospitalized for 7 days during treatment for hemolysis and an extensive, necrotic wound. Efforts are underway to develop an assay to provide a definitive diagnosis for the brown recluse spider bite, but none is yet commercially available. Antivenom is scarce; capture of the offending spider appears to be most helpful in the diagnosis and proper treatment of spider bites.     

Is injecting a finger with rabies immunoglobulin dangerous?

Treating potentially rabies virus infected wounds requires the injection of rabies immunoglobulin into and around the wounds, followed by vaccination with an approved tissue culture rabies vaccine. A significant number of such bite wounds involves fingers where there is little space for expansion. Injecting immunoglobulin into such areas under pressure may induce a compartment syndrome caused by compromising circulation. We carried out a retrospective review and a prospective study of patients seen with digital bite injuries and found that it is a safe procedure if carried out with care by experienced staff.     

Acute Generalized Exanthematous Pustulosis (AGEP) Triggered by a Spider Bite

BackgroundAcute generalized exanthematous pustulosis (AGEP) is a rare and severe cutaneous reaction usually triggered by drugs. Other causative factors such as viral infections are rarely involved. In this study, we report a case of AGEP caused by a spider bite.Case SummaryA 56-year-old woman was referred to the allergy unit after a spider bite at the left popliteal fossa, while gardening, 5 days earlier. The offending spider was captured and identified by an entomologist as belonging to the Loxosceles rufescens species. No acute reaction was observed; however, after 24 hours, due to the occurrence of typical dermonecrotic skin lesions associated with erythema and edema, Cefuroxime and Clindamycin were administered intramuscularly after medical advice was given. Almost 72 hours after the spider bite, an erythematous and partly edematous eruption appeared locally in the gluteus area bilaterally, which progressively expanded to the trunk, arms and femors. Within 24 hours dozens of small, pinhead sized, non- follicular pustules were present, mainly in the folds. The patient complained of a burning sensation of the skin in addition to pruritus; and simultaneously had a fever of 38-39 °C as the eruption expanded.DiscussionA spider bite may represent a possible causative factor of AGEP. A spider's venom contains sphingomyelinase that stimulates the release of IL8 and GM-CSF, which are involved in AGEP pathogenesis. Whether or not the con-current use of antibiotics has an effect in AGEP appearance when combined with a spider's venom, cannot be excluded.     

A retrospective review of black widow spider envenomation

Because there are few recent studies of black widow spider (Latrodectus Mactans) envenomation, a six-year retrospective study was conducted by patients admitted to or discharged from our hospital with this diagnosis. Fourteen patients with apparently severe envenomation were found and reviewed for the frequency of presenting signs and symptoms, the use of laboratory and radiographic studies, and the effectiveness of drug therapies. The most frequent symptoms were bite site pain (79%), abdominal pain (71%), and lower extremity weakness (57%). The most frequent signs were bite site lesions and abdominal tenderness or rigidity (71%). Laboratory and radiographic studies did not influence the initial emergency department evaluation. All drug therapies resulted in good clinical outcome despite two complications, and we therefore believe that the use of antivenom for symptomatic relief should be discouraged.     

Haemolytic Uremic Syndrome a Hitherto Unreported Complication of Humpnosed Viper Envenomation

Merrem’s humpnosed viper bite is known to cause incoagulable blood, acute renal failure, acute respiratory distress syndrome, Raynaud’s phenomenon and gangrene of the distal limb. Venom-induced consumptive coagulopathy (VICC) is the commonest coagulopathy that occurs following snake envenomation which is characterised by prolonged clotting times. In a small proportion of patients with VICC, microangiopathy is also seen. The authors report a novel case of haemolytic uraemic syndrome following a merrem’s humpnosed viper bite, which highlights the need for comprehensive and serial haematological evaluation to detect the condition and initiate timely plasma exchange. The authors recommend screening of all victims of humpnosed viper bite for haemolytic uremic syndrome which might otherwise be overlooked and stress the need for further studies to see the role of haemolytic uremic syndrome following humpnosed viper bite.     

Acute coronary syndrome following snake bite: a report of three cases from a tertiary care hospital in rural southern India

Snake bite is a common cause of preventable death in rural India which is often due to neurological complications and coagulopathy. We report on three patients who presented with bites and later developed acute coronary syndrome during the course of their stay in hospital. Such patients have to be managed conservatively because of their coexistent coagulopathy.     

Anterior tibial compartment syndrome following rupture of a popliteal cyst

 A ruptured popliteal cyst usually results in calf pain and swelling. We report the case of a patient with rheumatoid arthritis who developed anterior compartment syndrome of the leg following rupture of a popliteal cyst. Since acute compartment syndrome requires prompt treatment, clinicians should be aware of this rare complication. Received: May 17, 2002 / Accepted: August 9, 2002     

Ploy and counterploy in predator-prey interactions: Orb-weaving spiders versus bombardier beetles

Bombardier beetles (Brachinus spp.) offered to orb-weaving spiders are either captured or lost, depending on the attack strategy of the spider. Nephila clavipes grasps a beetle directly and attempts to bite it outright, but is repelled by the beetle's defensive spray. As the spider recovers from the spray, the beetle makes its escape from the web. Argiope first imprisons the beetle by wrapping it delicately in silk, without causing it to spray. When the spider then proceeds to bite, the wrapping protects it against the full effects of the spray. The wrapping strategy may be generally effective against chemically protected insects, and it is suggested that this may be one of its principal adaptive justifications.     

Utility of Doppler ultrasonography for diagnosing and assessing treatment effects in liver compartment syndrome

Liver compartment syndrome is a life-threatening complication of hepatic subcapsular hematoma; diagnosis and assessment of treatment effects are therefore important. We report a rare case of liver compartment syndrome due to spontaneous hepatic subcapsular hematoma without any underlying conditions, in which Doppler ultrasonography (US) proved useful in both diagnosis and assessment of treatment effects. A 32-year-old woman experienced sudden epigastralgia and was diagnosed with hepatic subcapsular hematoma in the right lobe, based on contrast-enhanced computed tomography. Hepatic arteriography showed active hemorrhage and Doppler US showed retrograde flow in the right portal vein. From these findings, we diagnosed hepatic subcapsular hematoma complicated with liver compartment syndrome, and performed embolization of the bleeding point and percutaneous hematoma drainage. After these medical procedures, normalized antegrade flow in the right portal vein was observed on Doppler US. No underlying conditions contributing to hematoma were identified. In this case, Doppler US was useful for both diagnosis and assessment of treatment effects in liver compartment syndrome. When we examine patients with hepatic subcapsular hematoma, Doppler US should be used to diagnose the presence of liver compartment syndrome and assess treatment effects.     

Bilateral leg compartment syndrome due to severe myonecrosis caused by inappropriate use of simvastatin

Bilateral leg compartment syndrome due to myonecrosis caused by inappropriate use of statins is a rare but potentially fatal complication of this lipid lowering medication. We report a case of a 39-year-old woman who presented with suspicious critical lower limb ischemia. Subsequently, bilateral leg compartment syndrome and myonecrosis developed. The primary cause of myonecrosis was due to misuse of simvastatin mistaken by the patient for a weight-reducing drug. Urgent fasciotomies were performed and the patient underwent urgent renal replacement therapy with continuous hemodialysis for acute renal failure due to myoglobinuria. After this complex treatment, the patient was discharged. She almost fully recovered with only a residual paresis of the left fibular nerve. According to literature, this is a unique case of bilateral compartment syndrome and myonecrosis with acute renal failure due to statin overdose leading to acute renal failure and bilateral fasciotomy.     

Toxic shock syndrome due to an infected human bite

We report a case of nonmenstrual toxic shock syndrome. A 21-year-old man presented with severe pain in the right hand after an altercation in which he sustained a bite from a person. Physical examination revealed a small abscess on the right proximal interphalangeal joint with edema in the fourth and fifth digits and tenderness of the flexor sheath. The patient was hypotensive with diffuse macular erythematous skin. He responded to surgical drainage and antibiotics.     

Hemodynamic Collapse Caused by Cardiac Dysfunction and Abdominal Compartment Syndrome in a Patient with Mitochondrial Disease

We herein report a case of mitochondrial disease with heart and intestinal tract involvement resulting in hemodynamic collapse. A 66-year-old woman was transferred to our hospital because of cardiogenic shock. Vasopressors were administered, and a circulatory support device was deployed. However, her hemodynamics did not improve sufficiently, and we detected abdominal compartment syndrome caused by the aggravation of chronic intestinal pseudo-obstruction as a complication. Insertion of a colorectal tube immediately decreased the intra-abdominal pressure, improving the hemodynamics. Finally, we diagnosed her with mitochondrial disease, concluding that the resulting combination of acute heart failure and abdominal compartment syndrome had aggravated the hemodynamics.     

A clinical and epidemiological study on spider bites in Turkey

ObjectiveTo classify and characterize spider bites among inquiries to the National Poison Information Center (NPIC) between 1995 and 2004, in terms of the epidemiology and clinical symptomatology.MethodsClinical and epidemiological data were obtained from the NPIC's patient records. The following information was recorded for each spider bite: demographics, circumstances of the bite, and local and systemic effects.ResultsA total of 82 cases were reported. The accidents were mostly seen during August. The gender distribution was 59.76% male, 37.20% female, and 2.44% unknown and the 20–29 age group presented more spider bites. Most of the cases were in the Central Anatolia, Marmara, Mediterranean, and Black Sea regions. Local symptoms were observed in 60.87% of the cases, including local pain, edema, redness, itching, debris, burning, and numbness. Systemic symptoms were observed such as nausea, vomiting, abdominal pain, lethargy, anxiety, weakness, somnolence, dyspnea, hypertension, hypotension, and hyperthermia.ConclusionsIn conclusion, these findings emphasize the presence of medically important spider species in Turkey. All patients and especially pediatric patients should be admitted to the hospital. Identification of spider species may be considered a useful clinical and epidemiological tool in determining the incidence and risk of spider bites.     

An unusual consequence of deep vein thrombosis.

We report here an unusual case in which deep vein thrombosis, limited to the infrapopliteal region, led to an anterior tibial compartment syndrome as a major complication in a patient who had undergone heart surgery shortly before.     

A case of intoxication after a bite by Latrodectus tredecimguttatus

A case of intoxication in Southern Bulgaria after a bite from the venomous spider Latrodectus tredecimguttatus is reported. The development of both local (acute pain, itching erythema, paraesthesiae in the area of the bite) and general (weakness, headache, dizziness, fever, vomiting, myalgia, muscle cramps) symptoms, which passed relatively easily, is described. The clinical picture and treatment are briefly commented on.