Therapeutic Plasma Exchange for Refractory Hemolysis After Brown Recluse Spider (Loxosceles reclusa) Envenomation.

Introduction: The brown recluse spider (BRS) (Loxosceles reclusa) envenomation can lead to multiple complications, including hemolysis. We present a case of refractory hemolysis after a BRS bite treated with therapeutic plasma exchange (TPE).

Case Report: A 17-year-old female presented with fever, fatigue, and dyspnea.

Bilateral optic neuropathy following bite from brown recluse spider (Loxosceles reclusa).

A 63-year-old female with history of a resected frontal lobe meningioma presented with bilaterally decreased vision after a bite from a brown recluse spider. The exam was significant for a left relative afferent pupillary defect, bilateral optic nerve pallor, decreased foveal sensitivity in the left eye and new bilateral visual field defects, despite stability of her meningioma. The findings remained stable at 1-year follow-up.

Characterization of Brown spider (Loxosceles intermedia) hemolymph: cellular and biochemical analyses.

This is the first study on the hemolymph from a spider of the Loxosceles genus. These animals are responsible for a great number of envenomation cases worldwide. Several studies on Loxosceles venoms have been published, and the knowledge about the venom and its toxins is considerable, not only regarding the biological and biochemical characterization, but also regarding structural, genetic and phylogenetic approaches.

Successful use of plasma exchange for profound hemolysis in a child with loxoscelism.

We describe a 6-year-old boy who presented with massive hemolysis, shock, disseminated intravascular coagulopathy, and acute renal failure after loxosceles envenomation. In this patient, plasma exchange therapy (PEX) successfully cleared the plasma from an initial hemolytic index of 2000 (equivalent to 2 g/dL hemoglobin, where optimetric laboratory evaluation is impossible) to an index of <50 (no detectable hemolysis). This allowed the PICU team to correct his coagulopathy, assess his degree of organ dysfunction, and provide routine laboratory assessments during continuous venovenous hemodiafiltration.

Acute kidney injury and dermonecrosis after Loxosceles reclusa envenomation.

Spiders of the Loxosceles species can cause dermonecrosis and acute kidney injury (AKI). Hemolysis, rhabdomyolysis and direct toxin-mediated renal damage have been postulated. There are very few reports of Loxoscelism from India.

Extreme pain from brown recluse spider bites: model for cytokine-driven pain.

Importance: Bites from the brown recluse spider (BRS) can cause extreme pain. We propose cytokine release as a cause of the discomfort and a central mechanism through glial cell upregulation to explain measured pain levels and time course.

Observations: Twenty-three BRS bites were scored at a probable or documented level clinically, and an enzyme-linked immunosorbent assay was used to confirm the presence of BRS venom.

First report of in vitro selection of RNA aptamers targeted to recombinant Loxosceles laeta spider toxins.

Background: Loxoscelism is the envenomation caused by the bite of Loxosceles spp. spiders. It entails severe necrotizing skin lesions, sometimes accompanied by systemic reactions and even death.

A randomized controlled trial of trypsin to treat brown recluse spider bites in Guinea pigs.

Brown recluse spider bites result in necrotic skin lesions for which there is no known antidote. Since venom toxins are proteins, a proteolytic enzyme like trypsin might be effective in reducing toxicity. The aim of this study was to conduct a randomized controlled trial of trypsin to treat brown recluse spider bites in guinea pigs.

Secondary hemophagocytic lymphohistiocytosis (HLH) from a presumed brown recluse spider bite.

Systemic loxoscelism is a rare complication after Loxosceles reclusa (brown recluse spider) envenomation. Loxosceles venom contains pro-inflammatory proteins, which have been shown to be elevated in patients with hemophagocytic lymph histiocytosis. We present a case of a 10-year-old male that developed presumed systemic loxoscelism, secondary hemophagocytic lymphohistiocytosis with hepatic dysfunction and renal failure.

Surgical treatment of a brown recluse spider bite: a case study and literature review.

Spider bite envenomation can cause local, constitutional, and/or systemic symptoms. The present case study reports on 5 years of follow-up for a "probable" brown recluse spider bite of the foot and ankle that was refractory to conservative treatment and was subsequently treated with surgery. The present case study reports the atypical occurrence of long-term peripheral neuropathy after necrotic arachnidism induced by "probable" brown recluse (Loxosceles recluse) envenomation, in a 46-year-old male.

Obtundation and Myocardial Infarction in a Case of Systemic Loxoscelism.

We report an atypical course of a likely brown recluse spider bite in a 79-year-old male. The Rader scale and venom detection by ELISA provide supporting evidence for a loxoscelism diagnosis. Obtundation and myocardial infarction occurred following a drop in hemoglobin to 6.

Clinicopathological course of acute kidney injury following brown recluse (Loxoscles reclusa) envenomation.

We report a case of severe systemic loxoscelism in a previously healthy young man. This was associated with a Coombs-positive hemolytic anemia, striking leukomid reaction, renal failure, respiratory failure and cardiovascular collapse. This is the first documented case of a renal biopsy in a patient with renal failure after envenomation by the brown recluse spider.

Brown Recluse spider bite mediated hemolysis: clinical features, a possible role for complement inhibitor therapy, and reduced RBC surface glycophorin A as a potential biomarker of venom exposure.

Background: The venom of Loxosceles reclusa (Brown Recluse spider) can cause a severe, life-threatening hemolysis in humans for which no therapy is currently available in the USA beyond supportive measures. Because this hemolysis is uncommon, relatively little is known about its clinical manifestation, diagnosis, or management. Here, we aimed to clarify the clinical details of envenomation, to determine the efficacy of the complement inhibitor eculizumab to prevent the hemolysis in vitro, and to investigate markers of exposure to Brown Recluse venom.

Phospholipase D toxins of brown spider venom convert lysophosphatidylcholine and sphingomyelin to cyclic phosphates.

Venoms of brown spiders in the genus Loxosceles contain phospholipase D enzyme toxins that can cause severe dermonecrosis and even death in humans. These toxins cleave the substrates sphingomyelin and lysophosphatidylcholine in mammalian tissues, releasing the choline head group. The other products of substrate cleavage have previously been reported to be monoester phospholipids, which would result from substrate hydrolysis.

Two successive necrotic lesions secondary to presumed loxosceles envenomation.

Brown recluse spider (Loxosceles reclusa) envenomations with subsequent necrotic skin lesions occur infrequently, and systemic loxoscelism is rarer still. We report a case of 2 successive developing necrotic lesions, each on adjacent medial aspects of the legs, secondary to presumed Loxosceles envenomation. A 31-year-old man with no significant past medical history presented to the emergency department with 2, large, necrotic lesions, 1 on each medial thigh.

Brown recluse spider bite to the upper lip.

Brown recluse spiders are predominantly found in south central United States. Their bites usually cause mild self-limiting reactions, although localized tissue necrosis and rare systemic, potentially fatal, envenomations are known to occur. Herein, we report an atypical presentation of a brown recluse bite in a 20 year old female who was admitted to the intensive care unit due to angioedema and cellulitis.

Seasonality of brown recluse populations is reflected by numbers of brown recluse envenomations.

A significant seasonal correlation was recently shown for brown recluse spider activity. Vetter (2011) observed brown recluse spiders were submitted by the general public predominantly during April-October. For patients with suspected brown recluse spider bites (BRSB), we have observed the same seasonality.

Emergency department death from systemic loxoscelism.

Systemic loxoscelism is a constitutional illness resulting from the bite of the brown recluse spider. In severe form, it may cause hemolysis, acute renal failure, and disseminated intravascular coagulation. More rarely, it may result in death.

Acute generalized exanthematous pustulosis and Coombs-positive hemolytic anemia in a child following Loxosceles reclusa envenomation.

Previously reported cases of acute generalized exanthematous pustulosis secondary to brown recluse spider bite have been questioned due to lack of identification of the spider or because of the concomitant administration of antibiotics. We report a 9-year-old boy who arrived at the emergency department with a confirmed Loxosceles reclusa bite to the neck. On the third day of hospitalization, he developed hundreds of monomorphous, sterile pustules, initially in intertriginous areas.

[Cutaneous necrotic loxoscelism. A case report].

Brown recluse (Loxosceles spp.) spiders are arachnid species known to cause necrotic arachnidism. The envenomation, described as loxoscelism, is associated with localized pain, erythema, and edema followed by the development of necrosis.

Seasonality of brown recluse spiders, Loxosceles reclusa, submitted by the general public: implications for physicians regarding loxoscelism diagnoses.

Many medically important animals exhibit fluctuating seasonal abundance such that risk from envenomation or disease is not constant throughout the year. As indicated by homeowner submissions, brown recluse spiders, Loxosceles reclusa, show seasonal peaks of activity during summer and paucity in winter. This information should be incorporated as part of the diagnostic algorithm for physicians when considering the probability of loxoscelism in endemic Loxosceles areas especially if a skin lesion occurs when spiders are scarce.

Suspected brown recluse envenomation: a case report and review of different treatment modalities.

Background: The Loxosceles reclusa, commonly known as the brown recluse spider, is responsible for virtually all cases of spider bites leading to a significant necrosis.

Case Report: We report the case of a 72-year-old man who presented to the Emergency Department complaining of back pain, weakness, and diarrhea. The patient stated that he sustained a bug bite 1 week before presenting to the hospital.