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Acute necrotic arachnidism with necrotising fasciitis and recurrent pneumothorax

Jasleen Duggal1, Swathi Sunil Rao2, Shiva Kumar Reddy1

  • 1Paediatrics, Nitte(Deemed to be University), KS Hegde Medical Academy, Mangalore, Karnataka, India.

BMJ Case Reports
|November 24, 2022
PubMed

Insights

Acute spider envenomation caused severe necrotizing fasciitis and lung injury in an infant. This case highlights the critical need to consider spider bites in unexplained, rapidly progressing infections.

Area of Science:

  • Toxicology
  • Dermatology
  • Pediatrics

Background:

  • Necrotizing fasciitis is a severe bacterial infection requiring prompt surgical and antibiotic treatment.
  • Spider envenomation is a less common cause of soft tissue necrosis, with varying clinical presentations.

Observation:

  • An infant presented with rapidly progressive fasciitis and dermo-myonecrosis following a suspected brown recluse spider (Loxosceles) bite.
  • The condition rapidly involved deeper tissues, leading to lung parenchyma necrosis, pneumatoceles, and respiratory failure.

Findings:

  • The infant developed severe necrotizing fasciitis and acute respiratory distress syndrome (ARDS) secondary to presumed Loxosceles envenomation.
  • Despite aggressive medical and surgical management, including ventilation and antibiotics, the infant experienced refractory hypoxemia and succumbed.

Implications:

  • This is the first reported fatal case of acute spider envenomation in India, emphasizing the potential severity of Loxosceles bites.
  • Clinicians should consider spider envenomation in cases of rapidly progressive, antibiotic-unresponsive necrotizing fasciitis, especially in endemic areas.

Keywords:
Air leaksDermatologicalMechanical ventilationPaediatric intensive care

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