Loxoscelism: Cutaneous and Hematologic Manifestations
Background. Brown recluse spider (BRS) envenomation can lead to significant morbidity through severe local reaction and systemic illness including acute hemolytic anemia, rhabdomyolysis, disseminated intravascular coagulopathy (DIC), and even death. We aim to describe the clinical features and the r...
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Wiley
2019-01-01
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| Series: | Advances in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2019/4091278 |
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| _version_ | 1832568184408899584 |
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| author | Ngan Nguyen Manjari Pandey |
| author_facet | Ngan Nguyen Manjari Pandey |
| author_sort | Ngan Nguyen |
| collection | DOAJ |
| description | Background. Brown recluse spider (BRS) envenomation can lead to significant morbidity through severe local reaction and systemic illness including acute hemolytic anemia, rhabdomyolysis, disseminated intravascular coagulopathy (DIC), and even death. We aim to describe the clinical features and the roles of antibiotics and steroids in the treatment of loxoscelism. Methods. We retrospectively identified nine patients (pts) at our institution who were admitted with moderate to severe loxoscelism. A chart review was performed to highlight important clinical features and effect of interventions. Results. Nine pts (age 18 to 53) presented with fever (6), rash (9), pain/swelling (4), and jaundice (2). Of these, 6 pts had antecedent spider bites documented. Five pts were discharged from Emergency Room (ER) with oral antibiotics for “cellulitis” and were readmitted with severe systemic symptoms, with almost half (45%) of the pts being admitted to the intensive care unit. The most common admission diagnosis was sepsis secondary to cellulitis (6). Four pts developed worsening dermonecrosis, and 3 received prompt incision and drainage (I&D) with debridement. Hemolytic anemia developed around day 5 after spider bite (average); the lowest mean hemoglobin level was 5.8g/dL, with average drop of 3.1 g/dL. Direct antiglobulin test (DAT) (for both complement and surface immunoglobulin) was positive in 4 out of 9 patients. Four pts received glucocorticoid therapy for their hemolytic anemia. The use of steroid and intravenous immunoglobulin (IV Ig) did not seem to show a difference in the time of recovery although those who received steroids required less blood transfusion (2.1 units less). All pts had a complete recovery within two weeks. Conclusion. Treatment of systemic loxoscelism involves aggressive supportive care including appropriate wound management, blood transfusions, intravenous fluid replacement, and appropriate antibiotic coverage. It is unclear at this time if glucocorticoids or IVIg has any beneficial impact on the treatment of severe loxoscelism. |
| format | Article |
| id | doaj-art-ec9bfd2dd4384596af88bdc58ff161dc |
| institution | Kabale University |
| issn | 1687-9104 1687-9112 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Advances in Hematology |
| spelling | doaj-art-ec9bfd2dd4384596af88bdc58ff161dc2025-02-03T00:59:39ZengWileyAdvances in Hematology1687-91041687-91122019-01-01201910.1155/2019/40912784091278Loxoscelism: Cutaneous and Hematologic ManifestationsNgan Nguyen0Manjari Pandey1Department of Internal Medicine, University of Tennessee Health Science Center, 956 Court Ave., Suite H314, Memphis, TN 38163, USADepartment of Hematology and Oncology, West Cancer Clinic, 7945 Wolf River Blvd, Germantown, TN 38138, USABackground. Brown recluse spider (BRS) envenomation can lead to significant morbidity through severe local reaction and systemic illness including acute hemolytic anemia, rhabdomyolysis, disseminated intravascular coagulopathy (DIC), and even death. We aim to describe the clinical features and the roles of antibiotics and steroids in the treatment of loxoscelism. Methods. We retrospectively identified nine patients (pts) at our institution who were admitted with moderate to severe loxoscelism. A chart review was performed to highlight important clinical features and effect of interventions. Results. Nine pts (age 18 to 53) presented with fever (6), rash (9), pain/swelling (4), and jaundice (2). Of these, 6 pts had antecedent spider bites documented. Five pts were discharged from Emergency Room (ER) with oral antibiotics for “cellulitis” and were readmitted with severe systemic symptoms, with almost half (45%) of the pts being admitted to the intensive care unit. The most common admission diagnosis was sepsis secondary to cellulitis (6). Four pts developed worsening dermonecrosis, and 3 received prompt incision and drainage (I&D) with debridement. Hemolytic anemia developed around day 5 after spider bite (average); the lowest mean hemoglobin level was 5.8g/dL, with average drop of 3.1 g/dL. Direct antiglobulin test (DAT) (for both complement and surface immunoglobulin) was positive in 4 out of 9 patients. Four pts received glucocorticoid therapy for their hemolytic anemia. The use of steroid and intravenous immunoglobulin (IV Ig) did not seem to show a difference in the time of recovery although those who received steroids required less blood transfusion (2.1 units less). All pts had a complete recovery within two weeks. Conclusion. Treatment of systemic loxoscelism involves aggressive supportive care including appropriate wound management, blood transfusions, intravenous fluid replacement, and appropriate antibiotic coverage. It is unclear at this time if glucocorticoids or IVIg has any beneficial impact on the treatment of severe loxoscelism.http://dx.doi.org/10.1155/2019/4091278 |
| spellingShingle | Ngan Nguyen Manjari Pandey Loxoscelism: Cutaneous and Hematologic Manifestations Advances in Hematology |
| title | Loxoscelism: Cutaneous and Hematologic Manifestations |
| title_full | Loxoscelism: Cutaneous and Hematologic Manifestations |
| title_fullStr | Loxoscelism: Cutaneous and Hematologic Manifestations |
| title_full_unstemmed | Loxoscelism: Cutaneous and Hematologic Manifestations |
| title_short | Loxoscelism: Cutaneous and Hematologic Manifestations |
| title_sort | loxoscelism cutaneous and hematologic manifestations |
| url | http://dx.doi.org/10.1155/2019/4091278 |
| work_keys_str_mv | AT ngannguyen loxoscelismcutaneousandhematologicmanifestations AT manjaripandey loxoscelismcutaneousandhematologicmanifestations |