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IMAGES IN ACADEMIC MEDICINE
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 256-259

Classic brown recluse spider bite


1 Department of Family Medicine, St. Luke's University Health Network, PA, USA
2 Department of Internal Medicine, St. Luke's University Health Network, PA, USA
3 Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

Correspondence Address:
Sudip Nanda
Department of Internal Medicine, St. Luke's University Hospital Network, 801 Ostrum Street, Bethlehem, PA 18015
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-5568.196867

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A 58-year-old female presented with leg paresthesia and rash. On presentation, the rash was most consistent with cellulitis and cephalexin was started. The next day vesicles appeared which were presumed to be shingles and acyclovir was started. They evolved into a fully necrotic lesion on day 4 and had the classic presentation of a brown recluse spider bite. Bite marks were missed at presentation. Brown recluse spider bites are commonly misdiagnosed 80% of the time. Brown recluse venom contains a variety of toxins which can lead to skin necrosis (37% of patients) that occurs via an unknown mechanism dependent on host neutrophils. Skin changes progress over 12–36 h and necrosis develops within several days. Treatment recommendations call for exclusion of other diagnoses and conservative management with local wound care, tetanus prophylaxis, and debridement. Other forms of treatment should be avoided. Our patient was treated with a skin graft with good results. The following core competencies are addressed in this article: Patient care and medical knowledge.


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