SHM Converge Scientific Abstract ePoster Gallery-A Deadly Bite: Clostridial Necrotizing Infection With Multiorgan Failure Following Spider Envenomation

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This case report describes a rare and catastrophic complication following a suspected spider bite in a 59-year-old unhoused man with multiple medical comorbidities, including type II diabetes, hepatitis C cirrhosis, autoimmune skin disease, and substance use disorder. He presented after three days of worsening left arm pain and swelling, with a small ulcerative wrist lesion, erythema, purulent drainage, and concern for compartment syndrome or necrotizing fasciitis. CT imaging showed diffuse soft tissue edema and subcutaneous stranding without abscess. He was started on broad-spectrum antibiotics and underwent urgent fasciotomy, debridement, irrigation, and carpal tunnel release. Intraoperative findings showed severely inflamed tissue, and cultures grew Clostridium perfringens.<br /><br />Despite treatment, his condition rapidly worsened by postoperative day 2, with severe abdominal pain, high anion gap metabolic acidosis, hypoglycemia, hepatocellular injury, rhabdomyolysis, DIC, and oligoanuric acute kidney injury. CT abdomen revealed mesenteric ischemia, and laparotomy confirmed extensive bowel necrosis with hemorrhage. CT chest showed ground-glass opacities and pulmonary edema consistent with acute lung injury. He required major abdominal surgery, including small bowel and colon resection, cholecystectomy, and end ileostomy, along with treatment for Candida peritonitis and renal replacement therapy.<br /><br />The patient remains dialysis-dependent with limited renal recovery and a guarded prognosis. The authors emphasize that this unusually severe course likely reflects not only the infection but also delayed care and social vulnerability. They highlight the importance of early recognition, aggressive treatment, and attention to social determinants of health in preventing poor outcomes.

Asset Subtitle

Linh N. Vo

Meta Tag

Author List Ahmadreza Ghasemiesfe, Lee D. Lam, Linh N. Vo, Shotaro Naganawa

Category Clinical Vignettes

Concept Spider Bite

Concept Necrotizing Soft Tissue Infection

Concept Compartment Syndrome

Concept Mesenteric Ischemia

Concept Envenomation

Distinguished Non-Finalist

Presenter Organization University of California, Davis School of Medicine

Presenting Author Linh N. Vo

Track Adult

Keywords

spider bite

Clostridium perfringens

necrotizing fasciitis

compartment syndrome

fasciotomy

mesenteric ischemia

bowel necrosis

acute kidney injury

DIC

social determinants of health

Spider Bite

Necrotizing Soft Tissue Infection

Compartment Syndrome

Mesenteric Ischemia

Envenomation