title: Necrotic arachnidism and intractable pain from recluse spider bites treated with lumbar sympathetic block: a case report and review of literature.
abstract: Brown recluse (Loxosceles reclusa) spider bites mainly occur in the southern and Midwestern United States. The clinical manifestation of brown recluse spider bites varies from skin irritation, a small area of tissue damage to neuropathic pain, necrotic arachnidism and severe systemic reactions such as acute renal failure and even death. Treatment is controversial and nonspecific. We describe a case of extensive right lower extremity tissue necrosis and intractable neuropathic pain treated with lumbar sympathetic block in a patient with a documented brown recluse spider bite. Both his pain and tissue necrosis improved significantly with lumbar sympathetic block with local anesthetic. After a series of lumbar sympathetic blocks, his symptoms resolved and lower extremity wound healed rapidly. We discuss the benefit of sympathetic blockade not only for neuropathic pain but also possibly as a treatment for necrotic arachnidism from a brown recluse spider bite.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St Louis, MO 63110, USA. yix@wustl.edu
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Yi
authors.forename: Jacob
authors.initials: J
authors.lastname: AuBuchon
authors.forename: Shawn
authors.initials: S
authors.lastname: Zeltwanger
authors.forename: John P
authors.initials: JP
authors.lastname: Kirby
mesh_terms: D000368:Aged; D001340:Autonomic Nerve Block / Q000379:methods*; D005728:Ganglia, Sympathetic; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D059408:Pain Management; D001098:Spider Bites / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome