Acute-on-Chronic Liver Failure Triggered by Cutaneous Loxoscelism

Area of Science:

• Hepatology
• Toxicology
• Dermatology

Background:

• Acute-on-chronic liver failure (ACLF) presents with high short-term mortality.
• Systemic inflammation and multi-organ failure characterize ACLF.
• Pro-inflammatory events can originate in the liver or elsewhere.

Observation:

• A 69-year-old male with alcohol-induced liver cirrhosis developed a severe skin lesion after a spider bite.
• The patient rapidly progressed to hepatic encephalopathy, respiratory failure, and hypotension.
• Laboratory findings included hypercreatininemia, elevated INR, and hyperbilirubinemia.

Findings:

• The patient was diagnosed with ACLF secondary to cutaneous loxoscelism.
• Absence of hemolytic anemia, rhabdomyolysis, and DIC ruled out visceral loxoscelism.
• This case demonstrates a unique presentation of severe liver injury from a spider bite.

Implications:

• Cutaneous loxoscelism can precipitate ACLF and multi-organ failure.
• Early recognition of spider bite envenomation is crucial in patients with underlying liver disease.
• This case expands the understanding of spider bite toxicity and its systemic effects.