title: Inappropriate diagnosis of necrotizing arachnidism. Watch out Miss Muffet--but don't get paranoid.
abstract: A 28-year-old man presented with painful progressive necrosis of the skin of his left leg which was associated with general toxicity and a high fever. A working diagnosis of necrotizing arachnidism was made, but no improvement followed two weeks of therapy with analgesics, antibiotics and antihistamines. His symptoms responded rapidly to prednisolone therapy, and a diagnosis of pyoderma gangrenosum was confirmed by biopsy. This subsequently proved to be associated with early acute myelomonocytic leukaemia.
authors.affiliation: Alfred Hospital, Prahran, VIC.
authors.forename: D R
authors.initials: DR
authors.lastname: Kemp
mesh_terms: D000328:Adult; D001706:Biopsy; D001856:Bone Marrow Examination; D003951:Diagnostic Errors; D005734:Gangrene / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007871:Leg Ulcer / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D015479:Leukemia, Myelomonocytic, Acute / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008297:Male; D011711:Pyoderma / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D001098:Spider Bites / Q000175:diagnosis / Q000473:pathology