Brown recluse spider bites in pregnant women - Tips from Other Journals

Date: June, 1992

Loxosceles reclusa is the most poisonous house spider in the United States. Fortunately, the brown recluse spider is a nocturnal creature, which tries to avoid humans. Almost all bites are clinically minor and do not require medical attention. Although no deaths have been proved to result from brown recluse spider bites, envenomation is potentially fatal. Large amounts of venom may induce rapid and severe hemolysis, activate complement and cause systemic clotting abnormalities and severe thrombocytopenia. Skin necrosis and systemic complaints may require medical evaluation and care. Anderson describes the clinical course of brown recluse spider bites in five healthy, pregnant women with probable or proven loxoscelism.

A localized, necrotic and painful ulcer commonly developed at the site of the spider bite. Rapid enlargement of the ulcer occurred in some patients. This cutaneous reaction was often accompanied by malaise, nausea, headache and myalgia. Generalized, toxic erythema of the skin was the most frightening but benign part of the reaction. As a general rule, this erythema suggests that the patient has some prior natural protective immunity. The rash often appeared first as a reticulated erythema or cutaneous flush all over the body, and then rapidly converted into a pruritic or tender papular rash resembling a drug eruption. Alternatively, purpura or ecchymoses appeared suddenly on the hands and feet, accompanied by swelling and pain or burning. Less commonly, hypotension and vasomotor reactions appeared, lasting for one to two weeks.

When patients present with significant signs and symptoms of loxoscelism, a thorough evaluation and laboratory tests are necessary to rule out a major coagulation disorder. In the five cases reported, a conservative, reassuring approach with close follow-up was effective. There was no evidence of increased rash during pregnancy. Early corticosteroid therapy may benefit the toxic erythema and prevent or reduce hemolysis and renal injury. However, corticosteroids do not block the skin ulceration. Early surgery for skin ulceration is unnecessary, since healing almost always occurs. Peeling of the extremities, recurrent diffuse tiny purpura and other cutaneous manifestations may appear as late as three weeks after the bite. (American Journal of Obstetrics and Gynecology, November 1991, vol. 165, p. 1454.)

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