Department of Internal Medicine, Kayseri City Training and Research Hospital, Kayseri, Turkey. E-mail.
Saudi Med J. 2020 Dec;41(12):1364-1368. doi: 10.15537/smj.2020.12.25544.
Loxosceles reclusa (L.reclusa) is known to bite humans, and its venom includes several enzymes that cause clinical symptoms. Loxoscelism, a condition due to being bitten by Loxosceles spiders, commonly known as recluses, can involve a range of clinical conditions, from local cutaneous lesions to severe systemic involvement. The diagnosis of loxoscelism is usually made by anamnesis and clinical findings. Magnetic resonance imaging is recommended for patients at high risk of necrotizing fasciitis. Treatment modalities are still controversial and there is no standardized treatment approach. Reported here, our case of loxoscelism involved a 24-year-old man presenting with a Loxosceles spider bite, dermonecrotic lesion, vomiting, diarrhea, acute renal injury, and rhabdomyolysis, who was successfully treated with hyperbaric oxygen therapy, therapeutic apheresis, hemodialysis, wound debridement, and cutaneous autografting. Early diagnosis and multidisciplinary approach can be life-saving in spider bites that can cause systemic involvement. Loxoscelism should be considered in patients with skin necrosis, acute renal injury, and rhabdomyolysis.
Loxosceles reclusa（L.reclusa）已知会叮咬人类，其毒液中包含几种会导致临床症状的酶。由于被 Loxosceles 蜘蛛（俗称隐士蜘蛛）咬伤而导致的类蝎毒，可能涉及一系列临床病症，从局部皮肤损伤到严重的全身受累。类蝎毒的诊断通常通过病史和临床发现来确定。对于有发生坏死性筋膜炎风险的患者，建议进行磁共振成像检查。治疗方式仍存在争议，且没有标准化的治疗方法。在此报告的病例中，一名 24 岁男性因被 Loxosceles 蜘蛛咬伤而出现皮肤坏死性病变、呕吐、腹泻、急性肾损伤和横纹肌溶解，经过高压氧治疗、治疗性血液清除、血液透析、清创和皮肤自体移植，成功治愈。对于可能导致全身受累的蜘蛛咬伤，早期诊断和多学科方法可能是救命的关键。对于出现皮肤坏死、急性肾损伤和横纹肌溶解的患者，应考虑类蝎毒。
