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Spider Envenomation, Widow: Differential Diagnoses & Workup

Author: Sean P Bush, MD, FACEP, Professor of Emergency Medicine, Loma Linda University School of Medicine; Consulting Staff, Envenomation Specialist, Department of Emergency Medicine, Loma Linda University Medical Center
Coauthor(s): Jennifer C Smith, MD, Medical Toxicology Fellow, Banner Good Samaritan Poison Center
Contributor Information and Disclosures

Updated: Jul 24, 2008

Differential Diagnoses

Acute Coronary Syndrome
Mesenteric Ischemia
Aneurysm, Abdominal
Millipede Envenomations
Anxiety
Myocardial Infarction
Appendicitis, Acute
Pregnancy, Ectopic
Back Pain, Mechanical
Scorpion Envenomations
Bites, Insects
Spider Envenomations, Brown Recluse
Caterpillar Envenomations
Spider Envenomations, Redback
Centipede Envenomations
Spider Envenomations, Tarantula
Cholecystitis and Biliary Colic
Hypocalcemia

Workup

Laboratory Studies

  • If the diagnosis is uncertain, laboratory studies to rule out alternative diagnoses (eg, acute abdomen, myocardial infarction) (eg, CBC, pregnancy test, cardiac markers).
  • The serum creatine kinase (CK) and peripheral white blood cell count may be elevated.

Imaging Studies

  • Consider performing an acute abdominal series or an abdominal CT scan if the diagnosis is unclear in a patient presenting with abdominal pain.

Other Tests

  • Skin testing variably may predict immediate hypersensitivity to antivenom and may influence the decision regarding its administration. Antivenom-induced anaphylaxis may be more life threatening than the envenomation itself.
  • Obtain an ECG, if indicated (eg, comorbidity, chest pain, severe hypertension).

More on Spider Envenomation, Widow

Overview: Spider Envenomation, Widow
Differential Diagnoses & Workup: Spider Envenomation, Widow
Treatment & Medication: Spider Envenomation, Widow
Follow-up: Spider Envenomation, Widow
Multimedia: Spider Envenomation, Widow
References

References

  1. Allen RC, Norris RL. Delayed use of widow spider antivenin. Ann Emerg Med. Sep 1995;26(3):393-4. [Medline].

  2. Boyer Hassen LV, McNally JT, Binford GJ. Spider bites. In: Auerbach PS, ed. Wilderness Medicine. 4th ed. St. Louis: Mosby-Year Book; 2001:807-838.

  3. Bush SP, Thomas TL, Chin ES. Envenomations in children. Pediatr Emerg Med Rep. 1997;2:1-12.

  4. Bush SP, Naftel J. Injection of a whole black widow spider. Ann Emerg Med. Apr 1996;27(4):532-3. [Medline].

  5. Bush SP. Black widow spider envenomation mimicking cholecystitis. Am J Emerg Med. May 1999;17(3):315. [Medline].

  6. Clark RF, Wethern-Kestner S, Vance MV, Gerkin R. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Ann Emerg Med. Jul 1992;21(7):782-7. [Medline].

  7. Cohen J, Bush S. Case report: compartment syndrome after a suspected black widow spider bite. Ann Emerg Med. Apr 2005;45(4):414-6. [Medline].

  8. Gonzalez Valverde FM, Gomez Ramos MJ, Menarguez Pina F, Vazquez Rojas JL. [Fatal latrodectism in an elderly man]. Med Clin (Barc). Sep 22 2001;117(8):319. [Medline].

  9. Langley RL, Morrow WE. Deaths resulting from animal attacks in the United States. Wild Environ Med. 1997;8:8-16.

  10. Pneumatikos IA, Galiatsou E, Goe D, Kitsakos A, Nakos G, Vougiouklakis TG. Acute fatal toxic myocarditis after black widow spider envenomation. Ann Emerg Med. Jan 2003;41(1):158. [Medline].

  11. Watson WA, Litovitz TL, Klein-Schwartz W, Rodgers GC Jr, Youniss J, Reid N, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].

  12. Woestman R, Perkin R, Van Stralen D. The black widow: is she deadly to children?. Pediatr Emerg Care. Oct 1996;12(5):360-4. [Medline].

  13. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). Dec 2007;45(8):815-917. [Medline].

  14. Hoxha R. Two Albanians die from black widow spider bites. BMJ. Aug 5 2006;333(7562):278. [Medline].

Further Reading

Keywords

black widow spider, spider bite, black widow spider bite, spider envenomation, Latrodectus, Latrodectus mactans mactans, brown widow, Latrodectus geometricus, red-legged widow, Latrodectus bishopi, redback spider, Latrodectus hasselti, button spider, Latrodectus indistinctus, Latrodectus variolus, Latrodectus hesperus, Latrodectus mactans tredecimguttatus, Latrodectus pallidus

Contributor Information and Disclosures

Author

Sean P Bush, MD, FACEP, Professor of Emergency Medicine, Loma Linda University School of Medicine; Consulting Staff, Envenomation Specialist, Department of Emergency Medicine, Loma Linda University Medical Center
Sean P Bush, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, International Society on Toxicology, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Protherics Consulting fee Consulting; Nycomed (formerly Fougera) Grant/research funds Speaking and teaching; Rare Disease Therapeutics Grant/research funds Research; Bioclon Grant/research funds Research

Coauthor(s)

Jennifer C Smith, MD, Medical Toxicology Fellow, Banner Good Samaritan Poison Center
Jennifer C Smith, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Robert L Norris, MD, Associate Professor, Department of Surgery; Chief, Division of Emergency Medicine, Stanford University Medical Center
Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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