Introduction: (LR), commonly known as the brown recluse spider, is endemic to the south central United States. We present a case of LR envenomation in a healthy adult male outside the usual geographic range, with atypical dermatologic and delayed, prolonged systemic loxoscelism (LX). This case demonstrates the importance of expanding the depth of knowledge of LR envenomations.
Case Report: A previously healthy 27 year-old male presented to an emergency department (ED) in central Virginia two hours after a LR envenomation to his left proximal arm. He was treated with diphenhydramine and discharged on oral methylprednisolone for a 5-day taper. On post-bite Days 1 and 2, the patient developed subjective fevers, chills, arthralgias, and myalgias, followed by a blanching, pruritic, morbilliform rash throughout his trunk and lower extremities. Post-bite Day 3, the patient presented to the ED again because of marked erythema of face and the right lateral thigh, and posterior and anterior trunk. Vital signs and laboratory analysis were generally unremarkable. The patient was observed overnight, and discharged with a prescription for prednisone 60 mg per day. On post-bite Day 7, the patient noted a petechial rash on the palms and soles and returned to the ED with a fever of 102.6 °F, a heart rate of 130 beats per minutes, and systolic blood pressure ranging 80-90 mmHg. After considering this may be an atypical presentation of LX, corticosteroids were increased to methylprednisolone 1 mg/kg IV every 6 h. The patient's condition slowly improved and he was discharged on post-bite Day 10. On post-bite Day 24, he had nearly complete resolution of skin findings.
Conclusions: LR envenomation can cause a variety of dermatological and systemic manifestations of toxicity. It is critical for toxicologists to be aware of the variety of presentations and findings to appropriately assess and treat LX.
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http://dx.doi.org/10.1080/15563650.2020.1798980 | DOI Listing |
Toxicon
February 2024
Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA, USA; Virginia Poison Center, Richmond, VA, USA.
This case report summarizes an envenomation by the Mangshan pit viper (Protobothrops mangshanensis), a rare, endangered, venomous snake endemic to Mount Mang of China, and the first reported use of Hemato Polyvalent antivenom (HPAV) for this species. The snakebite occurred in a United States zoo to a 46-year-old male zookeeper. He presented via emergency medical services to a tertiary center after sustaining a single P.
View Article and Find Full Text PDFJ Emerg Med
March 2023
Department of Emergency Medicine, University of Houston College of Medicine, Houston, Texas.
Background: Of the 8000-10,000 snake envenomations evaluated in U.S. emergency departments (ED) annually, approximately 1% are due to non-native snakes.
View Article and Find Full Text PDFTher Clin Risk Manag
July 2020
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Introduction: Green pit vipers (GPV) are widely distributed throughout Thailand and are responsible for significant morbidity. The primary objective of this study was to characterize clinical presentations and treatment methods for GPV bites. The secondary objective was to demonstrate the earliest and latest onset of hematotoxicity.
View Article and Find Full Text PDFClin Toxicol (Phila)
March 2021
Virginia Poison Center, Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA.
J Venom Anim Toxins Incl Trop Dis
February 2020
Laboratory of Biochemistry and Biophysics, Butantan Institute, São Paulo, SP, Brazil.
Background: Between 40,000-70,000 people die yearly of rabies, an incurable disease. Besides post-bite vaccination, no treatment is available for it.
Methods: First, virus dilution for antiviral effects in mice was determined.
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