A 28-Year-Old Man with Fever, Diaphoresis, and Nausea

Differential Diagnosis

• CA-MRSA skin infection
• Brown recluse spider envenomation
• Centipede envenoming
• Coumadin necrosis

Diagnosis

The correct diagnosis is brown recluse spider envenomation. The brown spiders (Loxosceles species) are found in temperate and tropical latitudes around the world. They live and build nests in dark areas, either indoors or outdoors.

 

Learnings

• Symptoms of brown recluse spider envenomation include reddened skin that may be followed by a blister at the site of the bite
• Short of capture or definitive identification, the diagnosis is clinical
• The North American brown recluse (L reclusa) is the most common species responsible for human injury in the U.S., but deaths are rare

 

Pearls for Urgent Care Management and Considerations for Transfer

• The wound site should be cleaned with soap and water, following by application of a topical antibiotic
• Ice may reduce pain and swelling
• Over-the-counter pain relievers may provide further relief
• If necrosis develops, patients can later follow up with plastic surgery