Makris Michael, Spanoudaki Nektaria, Giannoula Fani, Chliva Caterina, Antoniadou Anastasia, Kalogeromitros Dimitrios
Allergy Clinical Research Center, Allergy Unit, 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Medical School, University of Athens, Greece.
Allergol Int. 2009 Jun;58(2):301-3. doi: 10.2332/allergolint.08-CR-0035. Epub 2009 Mar 25.
Acute generalized exanthematous pustulosis (AGEP) is a rare and severe cutaneous reaction usually triggered by drugs. Other causative factors such as viral infections are rarely involved. In this study, we report a case of AGEP caused by a spider bite.
A 56-year-old woman was referred to the allergy unit after a spider bite at the left popliteal fossa, while gardening, 5 days earlier. The offending spider was captured and identified by an entomologist as belonging to the Loxosceles rufescens species. No acute reaction was observed; however, after 24 hours, due to the occurrence of typical dermonecrotic skin lesions associated with erythema and edema, Cefuroxime and Clindamycin were administered intramuscularly after medical advice was given. Almost 72 hours after the spider bite, an erythematous and partly edematous eruption appeared locally in the gluteus area bilaterally, which progressively expanded to the trunk, arms and femors. Within 24 hours dozens of small, pinhead sized, non-follicular pustules were present, mainly in the folds. The patient complained of a burning sensation of the skin in addition to pruritus; and simultaneously had a fever of 38-39 degrees C as the eruption expanded.
A spider bite may represent a possible causative factor of AGEP. A spider's venom contains sphingomyelinase that stimulates the release of IL8 and GM-CSF, which are involved in AGEP pathogenesis. Whether or not the con-current use of antibiotics has an effect in AGEP appearance when combined with a spider's venom, cannot be excluded.
急性泛发性脓疱病（AGEP）是一种罕见且严重的皮肤反应，通常由药物引发。其他致病因素如病毒感染很少涉及。在本研究中，我们报告一例由蜘蛛咬伤引起的AGEP病例。
一名56岁女性在5天前园艺时左腘窝被蜘蛛咬伤后被转诊至过敏科。肇事蜘蛛被昆虫学家捕获并鉴定为红螯蛛属物种。咬伤后未观察到急性反应；然而，24小时后，由于出现了与红斑和水肿相关的典型皮肤坏死性病变，在接受医疗建议后肌肉注射了头孢呋辛和克林霉素。蜘蛛咬伤后近72小时，双侧臀部局部出现红斑且部分水肿性皮疹，并逐渐蔓延至躯干、手臂和大腿。24小时内出现了数十个针头大小的非毛囊性小脓疱，主要分布在褶皱处。患者除瘙痒外还伴有皮肤烧灼感；随着皮疹扩展，同时出现38 - 39摄氏度的发热。
蜘蛛咬伤可能是AGEP的一个潜在致病因素。蜘蛛毒液中含有鞘磷脂酶，可刺激白细胞介素8（IL8）和粒细胞巨噬细胞集落刺激因子（GM - CSF）的释放，这些因子参与AGEP的发病机制。不能排除在蜘蛛毒液作用的同时使用抗生素对AGEP出现是否有影响。
