Exaggerated Arthropod Bite: A Case Report and Review of the Mimics

Abstract

Exaggerated arthropod bite reactions causing hemorrhagic or necrotic bullous lesions can mimic other serious conditions such as cutaneous anthrax, brown recluse spider bite, and tularemia. A 55- year-old, healthy woman presented to the emergency department with a 3.5-centimeter painless, collapsed hemorrhagic bulla at the left costal margin. She was afebrile and had no systemic symptoms. Laboratory evaluation was unremarkable. She was prescribed silver sulfadiazine cream and mupirocin ointment. The area denuded two days later and the lesion completely healed. This case illustrates the broad differential to be considered when evaluating patients with hemorrhagic bullous lesions.

An outbreak of acute hemorrhagic papules on the posterior neck in children during the COVID‐19 pandemic

“…These typically show edematous, painful or pruritic, hemorrhagic or necrotic nodules and bullae. This exuberant immune response can be caused by an underlying lymphoproliferative disorder or past T‐cell sensitization 1 . The children in this series were unique in that their lesions were minimally or non‐pruritic with scant surrounding inflammation.…”

Erythema multiforme triggered by a spider bite in an adult female patient

“…Spider bites are frequent, but most domestic spiders are not harmful for humans as they typically cause minor symptoms such as pruritic and small pink papules [3]. Rarely, fatal systemic immunologic reactions and severe local lesions occur [4].…”