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Spider Envenomation, Brown Recluse: Multimedia

Author: Thomas Arnold, MD, Medical Director, Louisiana Poison Control Center, Associate Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Aug 18, 2009

Multimedia

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Media file 1: Classic finding of a vesicle with surrounding erythema at 24 hours following brown recluse envenomation. Photo by Thomas Arnold, MD.

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Classic finding of a vesicle with surrounding erythema at 24 hours following brown recluse envenomation. Photo by Thomas Arnold, MD.

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Media file 2: Illustration of a brown recluse spider with the fiddle displayed prominently on its dorsum.

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Illustration of a brown recluse spider with the fiddle displayed prominently on its dorsum.

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Media file 3: Spider envenomations, brown recluse. Envenomation site on inner thigh untreated at 1 week. Photo by Thomas Arnold, MD.

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Spider envenomations, brown recluse. Envenomation site on inner thigh untreated at 1 week. Photo by Thomas Arnold, MD.

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Media file 4: Typical appearance of a male brown recluse spider. Photo contributed by Michael Cardwell, Victorville, Calif.

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Typical appearance of a male brown recluse spider. Photo contributed by Michael Cardwell, Victorville, Calif.

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Media file 5: Female brown recluse with size scale. Photo contributed by Michael Cardwell, Victorville, Calif.

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Female brown recluse with size scale. Photo contributed by Michael Cardwell, Victorville, Calif.

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Media file 6: Spider envenomations, brown recluse. Close-up image of dorsal violin-shaped pattern. Photo contributed by Michael Cardwell, Victorville, Calif.

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Spider envenomations, brown recluse. Close-up image of dorsal violin-shaped pattern. Photo contributed by Michael Cardwell, Victorville, Calif.

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Media file 7: Spider bite, brown recluse. Within an hour, the bite area swelled to the size of a quarter. The area turned blue and dark red by the evening of the first day, exceeding the boundaries of a circle drawn around the area of initial swelling by the patient's physician. Courtesy of Dale Losher.

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Spider bite, brown recluse. Within an hour, the bite area swelled to the size of a quarter. The area turned blue and dark red by the evening of the first day, exceeding the boundaries of a circle drawn around the area of initial swelling by the patient's physician. Courtesy of Dale Losher.

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Media file 8: Spider bite, brown recluse. The third day after the bite. The skin continues to die. Courtesy of Dale Losher.

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Spider bite, brown recluse. The third day after the bite. The skin continues to die. Courtesy of Dale Losher.

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Media file 9: Spider bite, brown recluse. Another view of the wound 3 days after the bite. Courtesy of Dale Losher.

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Spider bite, brown recluse. Another view of the wound 3 days after the bite. Courtesy of Dale Losher.

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Media file 10: Spider bite, brown recluse. Nine days after the bite. The patient endured 8 days with an open wound to drain the spider's toxins and needed intravenous antibiotics and pain medication almost 24 hours a day. Courtesy of Dale Losher.

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Spider bite, brown recluse. Nine days after the bite. The patient endured 8 days with an open wound to drain the spider's toxins and needed intravenous antibiotics and pain medication almost 24 hours a day. Courtesy of Dale Losher.

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Media file 11: Spider bite, brown recluse. Eleven days after the bite. A 5-inch wide area of dead tissue was excised, necessitating skin grafting. Courtesy of Dale Losher.

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Spider bite, brown recluse. Eleven days after the bite. A 5-inch wide area of dead tissue was excised, necessitating skin grafting. Courtesy of Dale Losher.

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Media file 12: Spider bite, brown recluse. Waiting to see skin graft results 38 days after the bite. Courtesy of Dale Losher.

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Spider bite, brown recluse. Waiting to see skin graft results 38 days after the bite. Courtesy of Dale Losher.

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Media file 13: Spider bite, brown recluse. Skin graft results 38 days after the bite. Courtesy of Dale Losher.

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Spider bite, brown recluse. Skin graft results 38 days after the bite. Courtesy of Dale Losher.

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Media file 14: Spider bite, brown recluse. View of healed wound approximately 10 months after bite. Courtesy of Dale Losher.

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Spider bite, brown recluse. View of healed wound approximately 10 months after bite. Courtesy of Dale Losher.

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Media file 15: Dermonecrotic arachnidism represents a local cutaneous injury with tissue loss and necrosis.

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Dermonecrotic arachnidism represents a local cutaneous injury with tissue loss and necrosis.

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Media file 16: Brown recluse spider. Courtesy of US Centers for Disease Control and Prevention.

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Brown recluse spider. Courtesy of US Centers for Disease Control and Prevention.

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Media file 17: Brown recluse spider. Courtesy of US Centers for Disease Control and Prevention.

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Brown recluse spider. Courtesy of US Centers for Disease Control and Prevention.

More on Spider Envenomation, Brown Recluse

Overview: Spider Envenomation, Brown Recluse

Differential Diagnoses & Workup: Spider Envenomation, Brown Recluse

Treatment & Medication: Spider Envenomation, Brown Recluse

Follow-up: Spider Envenomation, Brown Recluse

Multimedia: Spider Envenomation, Brown Recluse

References

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References

Miller LG, Spellberg B. Spider bites and infections caused by community-associated methicillin-resistant Staphylococcus aureus. Surg Infect. Fall 2004;5(3):321-2. [Medline].
Maynor ML, Moon RE, Klitzman B, Fracica PJ, Canada A. Brown recluse spider envenomation: a prospective trial of hyperbaric oxygen therapy. Acad Emerg Med. Mar 1997;4(3):184-92. [Medline].
Carlton PK Jr. Brown recluse spider bite? Consider this uniquely conservative treatment. J Fam Pract. Feb 2009;58(2):E1-6. [Medline].
Barrett SM, Romine-Jenkins M, Fisher DE. Dapsone or electric shock therapy of brown recluse spider envenomation?. Ann Emerg Med. Jul 1994;24(1):21-5. [Medline].
Burton KG. Nitroglycerine patches for brown recluse spider bites. Am Fam Physician. May 1 1995;51(6):1401. [Medline].
Dyachenko P, Ziv M, Rozenman D. Epidemiological and clinical manifestations of patients hospitalized with brown recluse spider bite. J Eur Acad Dermatol Venereol. Oct 2006;20(9):1121-5. [Medline].
Graham WR Jr. Adverse effects of dapsone. Int J Dermatol. Sep 1975;14(7):494-500. [Medline].
Hobbs GD, Anderson AR, Greene TJ, Yealy DM. Comparison of hyperbaric oxygen and dapsone therapy for loxosceles envenomation. Acad Emerg Med. Aug 1996;3(8):758-61. [Medline].
King LE Jr, Rees RS. Dapsone treatment of a brown recluse bite. JAMA. Aug 5 1983;250(5):648. [Medline].
Lowry BP, Bradfield JF, Carroll RG, Brewer K, Meggs WJ. A controlled trial of topical nitroglycerin in a New Zealand white rabbit model of brown recluse spider envenomation. Ann Emerg Med. Feb 2001;37(2):161-5. [Medline].
Mack RB. The bite of the spider woman. Loxosceles reclusa (the brown recluse). N C Med J. May 1992;53(5):200-3. [Medline].
Phillips S, Kohn M, Baker D, Vander Leest R, Gomez H, McKinney P, et al. Therapy of brown spider envenomation: a controlled trial of hyperbaric oxygen, dapsone, and cyproheptadine. Ann Emerg Med. Mar 1995;25(3):363-8. [Medline].
Rees R, Campbell D, Rieger E, King LE. The diagnosis and treatment of brown recluse spider bites. Ann Emerg Med. Sep 1987;16(9):945-9. [Medline].
Sams HH, Hearth SB, Long LL, Wilson DC, Sanders DH, King LE. Nineteen documented cases of Loxosceles reclusa envenomation. J Am Acad Dermatol. Apr 2001;44(4):603-8. [Medline].
Vetter RS, Barger DK. An infestation of 2,055 brown recluse spiders (Araneae: Sicariidae) and no envenomations in a Kansas home: implications for bite diagnoses in nonendemic areas. J Med Entomol. Nov 2002;39(6):948-51. [Medline].
Vetter RS, Bush SP. Reports of presumptive brown recluse spider bites reinforce improbable diagnosis in regions of North America where the spider is not endemic. Clin Infect Dis. Aug 15 2002;35(4):442-5. [Medline].
Wille RC, Morrow JD. Case report: dapsone hypersensitivity syndrome associated with treatment of the bite of a brown recluse spider. Am J Med Sci. Oct 1988;296(4):270-1. [Medline].
Wright SW, Wrenn KD, Murray L, Seger D. Clinical presentation and outcome of brown recluse spider bite. Ann Emerg Med. Jul 1997;30(1):28-32. [Medline].

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Keywords

Loxosceles reclusus, brown recluse spider, fiddleback spider loxoscelism, necrotic arachnidism, dermonecrotic arachnidism, spider bite, brown recluse bite, envenomations, Loxosceles laeta, morbilliform rash, disseminated intravascular coagulation, DIC, renal failure, seizures, coma, eschar, spider envenomation

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Contributor Information and Disclosures

Author

Thomas Arnold, MD, Medical Director, Louisiana Poison Control Center, Associate Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University Health Sciences Center
Thomas Arnold, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Louisiana State Medical Society, and Society for Academic Emergency Medicine
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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eMedicine Specialties > Emergency Medicine > Environmental

Spider Envenomation, Brown Recluse: Multimedia

Multimedia

Classic finding of a vesicle with surrounding erythema at 24 hours following brown recluse envenomation. Photo by Thomas Arnold, MD.

Illustration of a brown recluse spider with the fiddle displayed prominently on its dorsum.

Spider envenomations, brown recluse. Envenomation site on inner thigh untreated at 1 week. Photo by Thomas Arnold, MD.

Typical appearance of a male brown recluse spider. Photo contributed by Michael Cardwell, Victorville, Calif.

Female brown recluse with size scale. Photo contributed by Michael Cardwell, Victorville, Calif.

Spider envenomations, brown recluse. Close-up image of dorsal violin-shaped pattern. Photo contributed by Michael Cardwell, Victorville, Calif.

Spider bite, brown recluse. Within an hour, the bite area swelled to the size of a quarter. The area turned blue and dark red by the evening of the first day, exceeding the boundaries of a circle drawn around the area of initial swelling by the patient's physician. Courtesy of Dale Losher.

Spider bite, brown recluse. The third day after the bite. The skin continues to die. Courtesy of Dale Losher.

Spider bite, brown recluse. Another view of the wound 3 days after the bite. Courtesy of Dale Losher.

Spider bite, brown recluse. Nine days after the bite. The patient endured 8 days with an open wound to drain the spider's toxins and needed intravenous antibiotics and pain medication almost 24 hours a day. Courtesy of Dale Losher.

Spider bite, brown recluse. Eleven days after the bite. A 5-inch wide area of dead tissue was excised, necessitating skin grafting. Courtesy of Dale Losher.

Spider bite, brown recluse. Waiting to see skin graft results 38 days after the bite. Courtesy of Dale Losher.

Spider bite, brown recluse. Skin graft results 38 days after the bite. Courtesy of Dale Losher.

Spider bite, brown recluse. View of healed wound approximately 10 months after bite. Courtesy of Dale Losher.

Dermonecrotic arachnidism represents a local cutaneous injury with tissue loss and necrosis.

Brown recluse spider. Courtesy of US Centers for Disease Control and Prevention.

Brown recluse spider. Courtesy of US Centers for Disease Control and Prevention.

More on Spider Envenomation, Brown Recluse

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor