title: [Systemic loxoscelism presented in a pregnant patient].
abstract: BACKGROUND
  Loxoscelism is a condition caused by the inoculation of a series of proteolytic enzymes through the loxosceles spider bite (violinist). Morbidity and mortality is unknown in our country. The loxoscelism toxi-syndrome of local expression may have a good prognosis; however, viscera-cutaneus or systemic form has a serious and often fatal evolution. We report a case of a systemic variant developed in a pregnant patient.
  
  
  METHODS
  We present the first reported case of systemic loxoscelism in a pregnant patient, highlighting the survival of the mother-son, in the presence of viscera-cutaneus behavior. We describe the natural history of clinical expression, highlighting the benefit of current therapeutic antivenom fourth generation and immunoregulation role in supporting the therapeutic approach and the guideline of the surgical approach.
  
  
  CONCLUSIONS
  The appropriate multidisciplinary management coupled with an early use of antivenom limits the severity and the potential development of complications. Clinical suspicion is the cornerstone of therapeutic management of these patients.
authors.affiliation: Centro Toxicológico, Hospital General, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Distrito Federal, México. minitoxx@gmail.com.
authors.forename: María del Carmen
authors.initials: Mdel C
authors.lastname: Sánchez-Villegas
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodríguez-Álvarez
authors.forename: Concepción
authors.initials: C
authors.lastname: Ortega-Carrillo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Alagón-Cano
authors.forename: Jaime
authors.initials: J
authors.lastname: Zaldívar-Cervera
authors.forename: Jorge
authors.initials: J
authors.lastname: Loría-Castellanos
authors.forename: Norma Alicia
authors.initials: NA
authors.lastname: Urzúa-Rodríguez
mesh_terms: D000328:Adult; D000818:Animals; D063287:Brown Recluse Spider; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D001098:Spider Bites / Q000175:diagnosis* / Q000628:therapy
keywords: Antivenins; Arachnidism; Emergencies; Pregnancy