Therapeutic Plasma Exchange for Refractory Hemolysis After Brown Recluse Spider (Loxosceles reclusa) Envenomation

Abraham, Manjusha; Tilzer, Lowell L.; Hoehn, K. Sarah; Thornton, Stephen L.

doi:10.1007/s13181-015-0485-9

Cited by 28 publications

(15 citation statements)

References 12 publications

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“…Other studies have shown direct, immune-mediated mechanisms for thrombocytopenia and hemolysis in Loxosceles envenomation [ 4 , 10 , 13 ]. Additionally, numerous studies have found direct antiglobulin test-positive hemolysis 7 to 10 days into the course of Loxosceles envenomation, establishing an immune-mediated cause of hemolysis [ 4 , 10 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Viscerocutaneous Loxoscelism Manifesting with Myocarditis: A Case Report

et al. 2021

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Patient: Male, 16-year-old Final Diagnosis: Toxic myocarditis Symptoms: Cardiogenic shock • disseminated intravascular coagulation • heart failure Medication: — Clinical Procedure: Immunoglobulin therapy • plasmapharesis Specialty: Critical Care Medicine • Toxicology Objective: Rare coexistence of disease or pathology Background: Envenomation from the brown recluse spider ( Loxosceles reclusa ) is described to cause both local and systemic symptoms. We report a case of an adolescent boy who developed severe systemic loxoscelism, and his clinical course was complicated by myocarditis, which has not been previously reported in association with loxoscelism. Case Report: A 16-year-old boy presented with non-specific symptoms and forearm pain following a suspected spider bite, which subsequently evolved into a necrotic skin lesion. During his clinical course, he developed a characteristic syndrome of systemic loxoscelism with hemolysis, disseminated intravascular coagulopathy, and severe systemic inflammatory response syndrome, necessitating transfer to the Intensive Care Unit. The diagnosis was confirmed with an enzyme-linked immunosorbent assay that detected Loxosceles venom in the wound. Additionally, he developed pulmonary edema and cardiogenic shock secondary to myocarditis, which was confirmed with cardiac magnetic resonance imaging. Steroids and plasmapheresis were initiated to manage the severe inflammatory syndrome, and the myocarditis was treated with intravenous immunoglobulins, resulting in resolution of symptoms and improvement of cardiac function. Conclusions: This is the first reported case of myocarditis associated with loxoscelism, providing evidence for Loxosceles toxin-associated cardiac injury, which has been previously described in animal models only. Furthermore, this case provides further support for the use of confirmatory testing in the clinical diagnosis of loxoscelism.

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Section: Discussionmentioning

confidence: 99%

Viscerocutaneous Loxoscelism Manifesting with Myocarditis: A Case Report

et al. 2021

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“…Loxosceles reclusa ( L. reclusa ), better known as the brown recluse spider, is a small hunting spider commonly found in the central and southeastern parts of the USA [ 1 ]. Loxoscelism denotes systemic effects from the L. reclusa venom.…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis however is often missed or mislabeled as cellulitis or other skin infection [ 4 ]. The management of brown recluse spider bites is primarily supportive as there is no definitive intervention or guideline treatment [ 1 , 4 ]. Supportive care usually entails red blood cell transfusions, intravenous fluids, and local wound care [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Acute Hemolytic Anemia Caused by Loxoscelism Treated With Plasmapheresis: A Case Report

Harry¹,

Brugioni²,

Madhusudhana³

2022

J Med Cases

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The bite of a brown recluse spider ( Loxosceles reclusa ) is usually associated with skin necrosis; however, it can lead to more significant morbidity including acute hemolytic anemia, rhabdomyolysis, disseminated intravascular coagulopathy and death. Here we highlight a case using plasmapheresis as treatment for acute hemolytic anemia caused by the bite of a brown recluse spider. A 49-year-old male presented to the emergency room 5 days after suffering a spider bite due to worsening symptoms. He had worsening pain at the site of the bite, diffuse body myalgias, darkening of his urine, chills, and shortness of breath. Hematology was consulted to assist in the management of hemolytic anemia refractory to multiple blood transfusions, worsening acute kidney failure requiring hemodialysis, and concern for impending death. After a literature review suggesting plasmapheresis may be beneficial in this scenario, the case was discussed with the local blood bank, and plasmapheresis was initiated. The patient underwent plasmapheresis with albumin for 2 days and the patient’s hemoglobin improved and stabilized. Therapy of loxoscelism is directed at limiting the dermatonecrosis at the site of the envenomation and in cases of systemic illness supportive care is recommended. Therapeutic plasma exchange has been shown efficacious in treating snake envenomation, but there are limited data detailing its use for brown recluse spider envenomation. Here we present a case to highlight the benefit of plasmapheresis in a patient with acute hemolytic anemia secondary to a brown recluse spider bite.

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“…Cases of loxoscelism requiring TPE are rare in the literature. 10 In conclusion, because the early diagnosis of spider bites can facilitate multidisciplinary, live-saving approaches to treatment, loxoscelism should be considered in patients with skin necrosis, acute renal injury, and rhabdomyolysis.…”

mentioning

confidence: 99%

A loxoscelism case received therapeutic apheresis and hyperbaric oxygen therapy

Çetinkaya

Aydın

Sirakaya

et al. 2020

SMJ

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Loxosceles reclusa (L.reclusa) is known to bite humans, and its venom includes several enzymes that cause clinical symptoms. Loxoscelism, a condition due to being bitten by Loxosceles spiders, commonly known as recluses, can involve a range of clinical conditions, from local cutaneous lesions to severe systemic involvement. The diagnosis of loxoscelism is usually made by anamnesis, and clinical findings. Magnetic resonance imaging is recommended for patients at high risk of necrotizing fasciitis. Treatment modalities are still controversial and there is no standardized treatment approach. Reported here, our case of loxoscelism involved a 24-year-old man presenting with a Loxosceles spider bite, dermonecrotic lesion, vomiting, diarrhea, acute renal injury, and rhabdomyolysis, who was successfully treated with hyperbaric oxygen therapy, therapeutic apheresis, hemodialysis, wound debridement, and cutaneous autografting. Early diagnosis and multidisciplinary approach can be life-saving in spider bites that can cause systemic involvement. Loxoscelism should be considered in patients with skin necrosis, acute renal injury, and rhabdomyolysis.

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Therapeutic Plasma Exchange for Refractory Hemolysis After Brown Recluse Spider (Loxosceles reclusa) Envenomation

Cited by 28 publications

References 12 publications

Viscerocutaneous Loxoscelism Manifesting with Myocarditis: A Case Report

Viscerocutaneous Loxoscelism Manifesting with Myocarditis: A Case Report

Acute Hemolytic Anemia Caused by Loxoscelism Treated With Plasmapheresis: A Case Report

A loxoscelism case received therapeutic apheresis and hyperbaric oxygen therapy

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