Limb Salvage in Methicillin-Resistant Staphylococcus aureus (MRSA)-Complicated Necrotic Loxoscelism Through...

Loxosceles reclusa (brown recluse) envenomation may cause severe necrotic and systemic manifestations, with secondary bacterial infections remaining a major source of morbidity. We report the case of a 69-year-old man with chronic kidney disease, stage 2 hypertension, and prostate carcinoma who developed progressive necrosis of the left hand and forearm following a suspected spider bite. Laboratory findings showed leukocytosis, elevated C-reactive protein, and impaired renal function. Imaging demonstrated subcutaneous fluid collections. Surgical exploration revealed necrosis of the fascia and subcutaneous tissue, while muscular compartments remained viable. Wound cultures grew methicillin-resistant Staphylococcus aureus (MRSA). The patient received broad-spectrum antimicrobial therapy with linezolid, ceftazidime, and metronidazole, followed by vacuum-assisted closure therapy using the Lifotronic® Negative Pressure Wound Therapy System and a Wolfe-McGregor skin graft, achieving full recovery of the limb. This case highlights the efficacy of a multimodal approach combining targeted anti-MRSA therapy, negative pressure wound therapy, and reconstructive grafting in achieving limb salvage and preserving functional mobility in high-risk patients with complicated necrotic loxoscelism.