Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, USA.
SEHealth Cancer Center, SEHealth, Cape Girardeau, MO, USA.
Hematology. 2022 Dec;27(1):543-554. doi: 10.1080/16078454.2022.2065086.
Describe the development of warm autoimmune hemolytic anemia warm (AIHA) secondary to a brown recluse spider () bite is known as systemic loxoscelism; and review epidemiology, clinical manifestations, diagnostic work-up, pathophysiology, and treatment options associated with warm AIHA secondary to systemic loxoscelism.
Cases series of two cases of warm AIHA due to systemic loxoscelism and a review of the current literature: epidemiology, clinical manifestations, diagnostic work-up, pathophysiology, and treatment options associated with warm AIHA secondary to systemic loxoscelism.
Presented here are two cases of warm AIHA due to systemic loxoscelism. Each patient was generally healthy appearing and presented with symptomatic anemia in the setting of brown recluse spider bites. Both patients were eventually found to have warm AIHA. Upon recognition of the diagnosis, the patients were started on corticosteroids and aggressive intravenous fluid hydration. In addition, they received transfusions of packed red blood cells. Their clinical courses improved, and they recovered to eventually be discharged home.
Envenomation by a brown recluse spider, , can result in systemic loxoscelism which can cause warm AIHA. The diagnosis of warm AIHA is confirmed by the direct antiglobulin/Coomb's test. Warm AIHA can be a life-threatening disease process. Hemodynamic support with intravenous fluids and RBC transfusion is the initial step in the management of these patients. Corticosteroids are the mainstay of current management. Second line treatments include rituximab. Rarely patients require splenectomy for refractory disease. Corticosteroids should be tapered over a three-month period.
描述与褐色隐士蜘蛛（）咬伤相关的温自身免疫性溶血性贫血（AIHA）的发展，这种情况被称为全身性利什曼病；并回顾与系统性利什曼病相关的温 AIHA 的流行病学、临床表现、诊断方法、病理生理学和治疗选择。
对两例因系统性利什曼病引起的温 AIHA 病例进行病例系列研究，并对当前文献进行回顾：流行病学、临床表现、诊断方法、病理生理学和与系统性利什曼病相关的温 AIHA 的治疗选择。
本文介绍了两例因系统性利什曼病引起的温 AIHA。每位患者均表现为一般健康状况，并在褐色隐士蜘蛛咬伤的背景下出现症状性贫血。两名患者最终均被诊断为温 AIHA。在诊断得到确认后，患者开始接受皮质类固醇和积极的静脉补液治疗。此外，他们还接受了红细胞输注。他们的临床病程得到改善，最终康复出院。
褐色隐士蜘蛛的咬伤会导致全身性利什曼病，从而引起温 AIHA。温 AIHA 的诊断通过直接抗球蛋白/Coomb's 试验确认。温 AIHA 可能是一种危及生命的疾病过程。静脉输液和红细胞输注的血流动力学支持是这些患者治疗的初始步骤。皮质类固醇是目前治疗的主要方法。二线治疗包括利妥昔单抗。极少数患者需要脾切除术治疗难治性疾病。皮质类固醇应在三个月内逐渐减少。
