Acute necrotic arachnidism with necrotising fasciitis and recurrent pneumothorax.

BMJ Case Rep

Paediatrics, Nitte(Deemed to be University), KS Hegde Medical Academy, Mangalore, Karnataka, India.

Published: November 2022

AI Article Synopsis

  • A male infant developed swelling and fever, which quickly progressed to necrotizing fasciitis involving multiple body areas after a brown recluse spider was found in his cot.
  • The infant experienced severe complications, including lung damage and required invasive ventilation along with multiple interventions like drainage for pneumothoraces.
  • Unfortunately, despite aggressive treatment including antibiotics and corticosteroids, the infant succumbed to the effects of the spider venom, marking the first reported fatal case of its kind in India.

Article Abstract

A male infant presented with swelling of the left leg and fever. Over the next 2 days, the area developed fasciitis extending to the left thigh, abdomen, and lower chest. Meanwhile, the parents found a giant brown spider within the infant's cot belonging to the genus , otherwise called the brown recluse spider. The dermo-myonecrosis progressed to deeper tissues involving the lung parenchyma requiring invasive ventilation. CT of the thorax showed multiple pneumatoceles, and lung biopsy showed alveolar necrosis. The infant was treated with intravenous antibiotics and corticosteroids. We drained the pneumothoraces by thoracostomy and insertion of intercostal drainage tubes. The infant required respiratory support initially by conventional ventilation, which was escalated to high-frequency oscillatory ventilation. He had refractory hypoxaemia and died. This is the first fatal case of acute spider envenomation described in India. Spider envenomation must be considered in patients with sudden onset, rapidly progressive necrotising fasciitis unresponsive to antibiotic therapy.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693886PMC
http://dx.doi.org/10.1136/bcr-2022-253018DOI Listing

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