Department of Emergency Medicine, University of Maryland, Baltimore, Maryland.
Department of Emergency Medicine, University of Maryland Upper Chesapeake Medical Center, Bel Air, Maryland.
J Emerg Med. 2021 Dec;61(6):e151-e154. doi: 10.1016/j.jemermed.2021.02.035. Epub 2021 May 14.
Black widow spiders are distributed worldwide and, although rarely fatal, account for significant morbidity. Diagnosis can be challenging, and children are at risk of increased morbidity due to their small size.
We present a case of a 3-year-old boy who was brought to our emergency department because of sudden ear pain followed by labored breathing, abdominal pain, refusal or inability to speak, and grunting respirations. A black widow spider bite was suspected based on additional history obtained, and the spider was found in his helmet, confirming the diagnosis. The patient had progressive respiratory distress and somnolence and was intubated and transferred to a local pediatric intensive care unit. Antivenom was not initially available and eventually declined by the family. The child received supportive care and recovered after several days. Why Should an Emergency Physician Be Aware of This? This case illustrates the potentially deadly effects a black widow envenomation could cause in a child, and that bite location can affect the constellation of symptoms. It is a reminder that toxins, including that of the black widow spider, should be on the differential for acute abdominal pain, especially with autonomic features.
黑寡妇蜘蛛分布于世界各地，虽然很少致命，但会导致严重的发病率。诊断具有挑战性，由于儿童体型较小，他们的发病率风险增加。
我们报告了一例 3 岁男孩的病例，他因突发性耳部疼痛，随后出现呼吸困难、腹痛、拒绝或无法说话、呼噜呼吸而被带到我们的急诊部门。根据获得的其他病史，怀疑是黑寡妇蜘蛛咬伤，在他的头盔中发现了蜘蛛，从而确诊了诊断。患者呼吸窘迫逐渐加重并出现嗜睡，被插管并转至当地儿科重症监护病房。抗蛇毒血清最初不可用，最终被家属拒绝。几天后，孩子接受了支持性治疗并康复。
为什么急诊医生应该了解这个病例？该病例说明了黑寡妇蜘蛛咬伤可能对儿童造成的潜在致命影响，并且咬伤部位会影响症状的组合。这提醒我们，包括黑寡妇蜘蛛毒素在内的毒素应列入急性腹痛的鉴别诊断，尤其是具有自主特征的腹痛。
