Case of the Month

Brown Recluse bite: This 63 year old woman presented herself to the office with an evolving, tender lesion on her bicep area. Note the dark blue, small area in the center, where the bite occurred, surrounded by the dusky bluish white area, and then surrounded by redness. (This is the "red white blue" sign.) Also, note the irregular outline of the lesion. The brown recluse spider (also known as the violin or fiddle-back spider because of the violin-shaped area on the spider's back, which the patient brought in), is in the Loxosceles family of spiders. It is usually a timid spider, but will bite when threatened. The venom of the spider contains numerous chemicals that can cause problems with killing of red blood cells, as well as causing clotting of the blood and disruption of cell membranes. Whereas less than 10% of recluse bites lead to significant medical problems, when they do, patients can get headaches, nausea, vomiting, fever, chills, arthralgias, rash. In addition, renal failure and seizures have been known to occur. The lesions may take several months to heal, and might require skin grafting. In addition, rest, elevation, aspirin, and antibiotics may be given, as well as Dapsone, if the lesion is treated early enough.