SHM Converge Scientific Abstract ePoster Gallery-Not Your Average Spider Bite

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This case report describes a 17-year-old African American male in Kentucky who presented with right shoulder/neck pain, dyspnea, fatigue, and a skin lesion that was initially treated as cellulitis. Early workup showed fever, leukocytosis, elevated inflammatory markers, and negative imaging/cultures. Despite antibiotics, he developed worsening pain, rash, oxygen requirement, hematuria, elevated bilirubin and CK, and progressive anemia consistent with systemic loxoscelism from a brown recluse bite.<br /><br />His hospital course was complicated by diagnostic uncertainty because of his prior pulmonary embolism, morbid obesity limiting imaging, and autism spectrum disorder affecting symptom reporting. Serial labs showed worsening hemolysis, with hemoglobin falling to a nadir of 5.0 g/dL. He required rapid response activation, PICU transfer, incision and drainage of the lesion, broad-spectrum antibiotics, and a total of six packed red blood cell transfusions. He improved gradually and was discharged home after 13 days.<br /><br />The report emphasizes that brown recluse bites are often mistaken for cellulitis, and that systemic loxoscelism can cause severe hemolytic anemia, especially in children and adolescents. Because there is no antivenom, treatment is supportive, including close monitoring, transfusion, and management of complications. The authors also highlight the lack of representative dermatologic images of patients of color in medical literature, which can delay recognition and treatment of skin findings in non-White patients.

Asset Subtitle

Sarah McQuaide

Meta Tag

Author List Amelia Power, Anna E. Nelson, Derek Arrington, Klint M. Schwenk, Navjyot K. Vidwan, Sarah McQuaide

Category Clinical Vignettes

Concept Brown Recluse Spider Envenomation

Concept Necrosis

Concept Hemolysis

Concept Supportive Care

Concept Hemolytic Anemia

Distinguished Non-Finalist

Presenter Organization University of Louisville

Presenting Author Sarah McQuaide

Track Pediatric

Keywords

systemic loxoscelism

brown recluse bite

hemolytic anemia

cellulitis misdiagnosis

adolescent patient

packed red blood cell transfusion

skin lesion

dermatologic representation

autism spectrum disorder

pulmonary embolism

Brown Recluse Spider Envenomation

Necrosis

Hemolysis

Supportive Care

Hemolytic Anemia