Boissiere F, Masson R, Fluieraru S, Vitse J, Dessena L, Lefevre M, Bekara F, Herlin C
Département de chirurgie plastique et reconstructrice, CHRU Lapeyronie, 34295 Montpellier, France; Centre de traitement des brûlés, CHRU Lapeyronie, 34295 Montpellier, France; Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France.
Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France.
Ann Chir Plast Esthet. 2016 Dec;61(6):811-819. doi: 10.1016/j.anplas.2016.08.005. Epub 2016 Sep 28.
Loxosceles spiders are ubiquitous and responsible for many cases of envenomation in the world. The kind rufescens is present in the Provence and Occitan regions in France. During the summer 2015, we faced many Loxosceles rufescens cases of bites having led to extensive integumental necrosis whose features and singular evolution seems important to report.
We report the cases of nine patients who experienced a spider bite in the summer of 2015 in the Languedoc Roussillon.
Of nine patients, eight patients had skin necrosis and five required surgical care. Five patients had a fever and had five other general signs such as important asthenia, joint pain, nausea and dizziness. CRP was very low normal in all patients. Finally, five of the nine patients reported a residual pain.
L. rufescens is a small spider (7 to 15mm in diameter) having a cytotoxic venom. Loxoscelism diagnosis is usually made by removing a front necrotic skin lesion. Of systemic loxoscelism that have been described, some American species had fatal outcomes. The treatment remains controversial with various options: surgery, antibiotics, antihistaminics, antivenom.
The diagnosis must be made in endemic areas when confronted to a necrosic integumentary infectious rapidly progressive, unresponsive to antibiotic treatment associated with atypical general signs.
棕色遁蛛分布广泛，在全球导致了许多中毒案例。棕遁蛛在法国的普罗旺斯和奥克西塔尼地区存在。在2015年夏天，我们遇到了许多棕遁蛛咬伤案例，这些咬伤导致了广泛的皮肤坏死，其特征和独特的演变似乎很值得报告。
我们报告了2015年夏天在朗格多克-鲁西永地区遭受蜘蛛咬伤的9名患者的病例。
9名患者中，8名患者出现皮肤坏死，5名需要手术治疗。5名患者发烧，还有5名有其他一般症状，如严重乏力、关节疼痛、恶心和头晕感。所有患者的CRP均处于非常低的正常水平。最后，9名患者中有5名报告有残留疼痛。
棕遁蛛是一种小型蜘蛛（直径7至15毫米），具有细胞毒性毒液。棕蛛中毒的诊断通常通过切除前部坏死性皮肤病变来进行。在已描述的全身性棕蛛中毒案例中，一些美洲种类有致命后果。治疗仍然存在争议，有多种选择：手术、抗生素、抗组胺药、抗蛇毒血清。
在流行地区，当面对迅速进展、对抗生素治疗无反应且伴有非典型一般症状的坏死性皮肤感染时，必须做出诊断。
