Clinical Presentation and Outcome of Brown Recluse Spider Bite

Byline: Seth W Wright, Keith D Wrenn, Lindsay Murray, Donna Seger Abstract: Study objective: To examine the clinical presentation and outcome of patients treated in the ED or toxicology clinic for suspected brown recluse spider bites. Methods: We assembled a retrospective case series of patients at a southeastern US university hospital. Our study group comprised 111 patients with suspected brown recluse spider bites treated during a 30-month period. Our main outcome measures were the need for skin grafting and the development of other complications. Results: The mean age of our subjects was 34[+ or -]17 years. Thirteen patients (12%) brought the spider to the hospital, 22 (20%) saw a spider at the time of the bite, and an exclusively clinical diagnosis was made in the remaining 76 (68%). Most wounds (59%) involved the leg. At the time of presentation, 81% had central discoloration and 37% necrosis. Sixteen patients (14%) were systemically ill, and 6 (5%) were admitted to the hospital. Most (86%) were treated with antibiotics. Dapsone was infrequently used (9%) and had usually been prescribed before the patient's presentation to our ED. Only three patients (3%; 95% confidence interval, 1% to 8%) required skin grafting. Mild hemolytic anemia developed in one patient, and another had mild hemolysis and a mild coagulopathy; neither patient was taking dapsone. No deaths or serious complications occurred in our study group. Conclusion: In our series, long-term outcome after brown recluse spider bite was good. Serious complications were rare, as was the need for skin grafting. Because the vast majority of bites heal with supportive care alone, aggressive medical therapy does not appear warranted. [Wright SW, Wrenn KD, Murray L, Seger D: Clinical presentation and outcome of brown recluse spider bite. Ann Emerg Med July 1997;30:28-32.] Article History: Received 29 April 1996; Revised 6 September 1996; Revised 28 January 1997; Accepted 6 February 1997 Article Note: (footnote) [star] From the Department of Emergency Medicine* and the Center for Clinical Toxicology,a Vanderbilt University Medical Center, Nashville, TN., [star][star] Reprint no. 47/1/81996 , a Address for reprints: Seth W Wright, MD, Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37212