Warm Weather, Hidden Threats: A Brown Recluse Bite Case Report by LILAH KAHLOON, BS, M3; & BARBARA SCHRODT, MD
Figure 1( left) Well demarcated necrotic plaque with surrounding erythema after biopsy collection.
Figure 2( right) Necrotic plaque after undergoing surgical debridement.
Br o w n r e c l u s e( Loxosceles reclusa) spider bites can be of significant medical concern in the southeastern and midwestern U. S., including Kentucky, where the species is most prevalent. 1 Although the exact incidence of brown recluse bites is difficult to determine due to misdiagnosis and underreporting, it is estimated that thousands of suspected bites occur annually in endemic areas, particularly in warmer months. 1, 2 These bites can lead to a range of clinical manifestations. Many presentations of brown recluse bites are limited to small erythematous lesions. 1 However, the development of an expanding area of necrosis with systemic symptoms is possible. 3 Rarely, hemolysis or disseminated intravascular coagulation may occur. 4 Due to the often-delayed presentation and varied severity of symptoms, diagnosis and management can be challenging. 5 Without visualization of the spider, a diagnosis of brown recluse envenomation relies heavily on assessment of lesion characteristics and the patient’ s history. 1, 2 This case report details the presentation, diagnosis and treatment of a brown recluse spider bite in Kentucky, highlighting the importance of early recognition and appropriate medical intervention.
A 17-year-old male with a history of atopic dermatitis and MRSA skin infection at age six presented with acute onset of a painless angular plaque on the left anterior thigh in June. Within a two-week period, the lesion expanded in diameter from 1 cm to 4 cm and developed necrosis. The patient reported no history of recent domestic or international travel. After this period of growth, a bacterial swab culture was initially obtained and returned negative. The patient developed a persistent fever of 101 ° F and the area around the lesion was warm upon physical examination. The area was initially treated with warm compress, antimicrobial wash, gentamicin ointment and hydrocolloid dressings for five days without significant improvement.
A skin biopsy was next obtained for histopathological examination, which revealed eosinophilic infiltrate, vasculitis and vasculopathy. Histological findings of L. reclusa bites can vary based on when biopsies are collected and tend to be nonspecific across instances of envenomation. 1, 6 A study analyzing specimens of brown recluse
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