Loxoscelism is envenomation by the brown recluse spider (Loxoscelesreclusa). Viscerocutaneous (VCT) loxoscelism is an uncommon systemic reaction to the venom.
Patient selection: bite of the brown recluse spider
VCT loxoscelism is more common in children than adults.
Clinical features of viscerocutaneousloxoscelism:
(1) nausea and vomiting
(2) high fevers
(3) arthralgias
(4) variable rhabdomyolysis
(5) variable hemolytic anemia, thrombocytopenia and/or DIC
(6) variable acute generalized exanthematous pustulosis with subsequent desquamation
(7) skin necrosis at the site of the spider bite
where:
• The hemolytic anemia may be Coombs-positive.
The diagnosis requires exclusion of other causes. The condition may initially be diagnosed as sepsis. It may also be confused with vasculitis, drug reaction, viral infection or erythema nodosum.
