Overview
What is the prevalence of brown recluse spider envenomation?
Which clinical syndromes result from brown recluse spider envenomation?
What is the pathophysiology of brown recluse spider envenomation?
What causes dermonecrotic arachnidism?
What is the frequency of brown recluse spider envenomation in the US?
In which age groups is brown recluse spider envenomation most frequent?
What is the prognosis of brown recluse spider envenomation?
Where can patient education resources for brown recluse spider envenomation be found?
Presentation
What are the signs and symptoms of brown recluse spider envenomation?
What are the symptoms of systemic loxoscelism due to brown recluse spider envenomation?
Which physical findings are characteristic of brown recluse spider envenomation?
What are potential complications of brown recluse spider envenomation?
DDX
What are the differential diagnoses for Brown Recluse Spider Envenomation?
Workup
What is the role of lab studies in the workup of brown recluse spider envenomation?
What is the role of flow cytometry in the workup of brown recluse spider envenomation?
What is the role of debridement in the management of brown recluse spider envenomation?
Treatment
What is included in emergency department (ED) care for brown recluse spider envenomation?
When is inpatient care indicated for brown recluse spider envenomation?
Which specialist consultations are helpful in the treatment of brown recluse spider envenomation?
How is brown recluse spider envenomation prevented?
What is included in long-term monitoring following treatment for brown recluse spider envenomation?
Medications
Which medications are used in the treatment of brown recluse spider envenomation?
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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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Illustration of a brown recluse spider with the fiddle displayed prominently on its dorsum.
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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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Typical appearance of a male brown recluse spider. 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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Spider envenomations, brown recluse. Close-up image of dorsal violin-shaped pattern. Photo contributed by Michael Cardwell, Victorville, Calif.
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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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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. Another view of the wound 3 days after the bite. 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 multiple doses of intravenous antibiotics and pain medication. 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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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. Skin graft results 38 days after the 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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Dermonecrotic arachnidism represents a local cutaneous injury with tissue loss and necrosis.
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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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Complete distribution range of wild and domestic Loxosceles reclusa (brown recluse spider). Courtesy of Wikimedia Commons (By ReliefUSA_map.gif: Public domain, U.S. government derivative work: Bob the Wikipedian).
