title: Acute generalized exanthematous pustulosis and Coombs-positive hemolytic anemia in a child following Loxosceles reclusa envenomation.
abstract: Previously reported cases of acute generalized exanthematous pustulosis secondary to brown recluse spider bite have been questioned due to lack of identification of the spider or because of the concomitant administration of antibiotics. We report a 9-year-old boy who arrived at the emergency department with a confirmed Loxosceles reclusa bite to the neck. On the third day of hospitalization, he developed hundreds of monomorphous, sterile pustules, initially in intertriginous areas. The eruption disseminated and was followed by pinpoint desquamation typical for acute generalized exanthematous pustulosis. During this he also developed late onset Coombs-positive hemolytic anemia and systemic loxoscelism. Sphingomyelinase in Loxosceles venom induces the production of interleukin-8 and granulocyte-macrophage colony-stimulating factor, cytokines involved in the pathogenesis of acute generalized exanthematous pustulosis, providing a mechanism by which Loxosceles reclusa bite may trigger acute generalized exanthematous pustulosis. We suggest that this case adds Loxosceles envenomation to the spectrum of agents that can trigger acute generalized exanthematous pustulosis.
authors.affiliation: Department of Dermatology, University of Missouri, Columbia, Missouri.
authors.forename: Leanna
authors.initials: L
authors.lastname: Lane
authors.affiliation: Department of Dermatology, University of Missouri, Columbia, Missouri.
authors.forename: Holly H
authors.initials: HH
authors.lastname: McCoppin
authors.affiliation: Department of Dermatology, University of Missouri, Columbia, Missouri.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dyer
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000175:diagnosis / Q000209:etiology*; D000743:Anemia, Hemolytic / Q000175:diagnosis / Q000209:etiology*; D001803:Blood Transfusion; D002648:Child; D003298:Coombs Test; D004298:Dopamine / Q000627:therapeutic use; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000096:biosynthesis; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006801:Humans; D016209:Interleukin-8 / Q000096:biosynthesis; D008297:Male; D010727:Phosphoric Diester Hydrolases / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy; D013108:Sphingomyelin Phosphodiesterase / Q000009:adverse effects; D013111:Spider Venoms / Q000009:adverse effects*; D016896:Treatment Outcome; D014558:Urobilinogen / Q000652:urine
chemical_list: D016209:Interleukin-8; D013111:Spider Venoms; C055161:loxosceles venom; D014558:Urobilinogen; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D010727:Phosphoric Diester Hydrolases; D013108:Sphingomyelin Phosphodiesterase; D004298:Dopamine
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