Monsignor Dimiccoli Hospital, Italy.
Salvatore Maugeri Foundation Scientific Institute of Pavia Via Maugeri, Italy.
Toxicon. 2020 May;179:107-110. doi: 10.1016/j.toxicon.2020.03.002. Epub 2020 Mar 13.
Latrodectism is a rare, but potentially severe, clinical syndrome caused by spider of the genus Latrodectus. L. tredecimguttatus is widespread in Italy and its bite cause the injection of α-latrotoxin that cause depletion of acetylcholine at motor nerve endings and release of catecholamines at adrenergic nerve endings. We describe the first clinical case of L. tredecimguttatus poisoning successfully treated with L. mactans antivenom from North America.
A healthy 60-year-old patient was admitted to the emergency department after unknown insect sting or arachnid/snake bite. In the early morning, the patient was working in the countryside when he felt a sting-like pain in the medial area of the right lower leg, associated with an intense burning sensation. An hour later he developed agitation, hoarseness, sweating, abdominal distress and intense pain in his right leg. In the emergency room vital signs showed a hypertensive crisis, tachycardia and peripheral oxygen desaturation. ECG was normal and ABE showed mixed acid-base disorder. Blood tests showed leukocytosis with neutrophilia, high levels of myoglobin, with normal coagulation and normal plasmatic cholinesterase. Neck, thorax and abdomen CT scan, with and without contrast medium, was negative. Four hours after admission hypertension worsened with board like rigid abdomen and onset of fasciculations, tremors, miosis and intense regional sweating. The definitive diagnosis of poisoning by L tredecimguttatus was based on the clinical picture. Within short time the antidote was provided by the Poison Centre and administered. A marked improvement of the symptomatology was noted after 30 minutes, and 1 hour later all symptoms were under control. The patient was discharged after 2 days.
The clinical presentation of a patient suffering from latrodectism places the clinician in front of a challenging differential diagnosis. Following the suspicion, the first-line doctor is invited to discuss the case with a toxicologist, in order to confirm or exclude the diagnosis and implement all therapeutic measures. In our clinical case, the absence of organic lesions, laboratory tests not suggestive for other causes, and the presence of typical clinical feature suggested the diagnosis of L tredecimguttatus poisoning. This hypothesis was then supported by the close temporal relation between antivenom administration and symptoms improvement. With this case, we report the first use of L mactans antivenom from North America to treat L.tredecimguttatus poisoning and we confirm its effectiveness in counteracting latrodectism caused by this spider.
拉托中毒是一种罕见但潜在严重的临床综合征，由拉氏蛛属（Latrodectus）蜘蛛引起。L. tredecimguttatus 在意大利广泛分布，其咬伤会导致α-拉毒素的注入，从而导致运动神经末梢乙酰胆碱耗竭和肾上腺素能神经末梢儿茶酚胺释放。我们描述了首例成功使用来自北美的 L. mactans 抗蛇毒血清治疗 L. tredecimguttatus 中毒的临床病例。
一名 60 岁健康患者在被未知昆虫叮咬或蛛形纲动物/蛇咬伤后被送入急诊部。清晨，患者在乡下工作时，右小腿内侧感到刺痛，并伴有强烈的烧灼感。一个小时后，他出现躁动、声音嘶哑、出汗、腹部不适和右腿剧痛。在急诊室，生命体征显示高血压危象、心动过速和外周血氧饱和度降低。心电图正常，ABE 显示混合酸碱紊乱。血液检查显示白细胞增多伴中性粒细胞增多、肌红蛋白水平升高、凝血正常和血浆胆碱酯酶正常。颈部、胸部和腹部 CT 扫描，有和无造影剂，均为阴性。入院后 4 小时，高血压恶化，出现板状刚性腹部和肌束震颤、震颤、瞳孔缩小和剧烈局部出汗。根据临床表现，明确诊断为 L tredecimguttatus 中毒。在短时间内，毒物中心提供了解毒剂并进行了治疗。30 分钟后，症状明显改善，1 小时后所有症状均得到控制。患者在 2 天后出院。
患有拉托中毒的患者的临床表现给临床医生带来了具有挑战性的鉴别诊断。怀疑后，主治医生被邀请与毒理学家讨论病例，以确认或排除诊断并实施所有治疗措施。在我们的临床病例中，缺乏器质性病变、实验室检查结果不提示其他原因，以及存在典型的临床特征提示 L tredecimguttatus 中毒的诊断。随后，抗蛇毒血清的使用与症状改善之间的密切时间关系支持了这一假设。通过这个病例，我们报告了首例使用来自北美的 L mactans 抗蛇毒血清治疗 L.tredecimguttatus 中毒，并证实其对抗该蜘蛛引起的拉托中毒的有效性。
