title: Documented cutaneous loxoscelism in the south of France: an unrecognized condition causing delay in diagnosis.
abstract: BACKGROUND
  Loxoscelism is an envenomation due to a bite by spiders of the genus Loxosceles, very well known on the American continent but unrecognized in Europe.
  
  
  METHODS
  We report the case of a 36-year-old woman, without any medical history or treatment, who went to a University Hospital in the South of France, for a painful skin lesion on the internal part of her left thigh, which appeared in the morning and developed rapidly during the day. She was directed to the infectious disease department with a diagnosis of skin infection. In spite of the antibiotics, the lesion increased, with a hemorrhagic central blister, an irregular ecchymotic center, a pale perimeter, and an extensive inflammatory and indurate oedema affecting the whole thigh. There was also a low-grade fever, chills, intense pain and a generalized scarlatiniform exanthema. The lesion was finally diagnosed as cutaneous loxoscelism, then confirmed by collection and identification of a Loxosceles rufescens spider killed by the patient the morning of the occurrence of the lesion. Following an initial symptomatic treatment, the development of a necrotic ulcer justified a delayed surgical reconstruction, after stabilization of the lesion.
  
  
  CONCLUSIONS
  Loxosceles bites are usually painless and rarely noticed by patients, often leading to a presumptive diagnosis. Therefore, in the case of a dermonecrotic lesion developing unfavourably with antibiotics, cutaneous loxoscelism should be one of the diagnoses to be considered.
authors.affiliation: Infectious Disease Department, University Hospital of Nîmes, Place du Professeur Robert Debré, 30029, Nîmes Cedex 09, France.
authors.forename: Emma
authors.initials: E
authors.lastname: Rubenstein
authors.affiliation: Department of Dermatology, University Hospital of Nîmes, Nîmes Cedex 09, France.
authors.forename: Pierre Emmanuel
authors.initials: PE
authors.lastname: Stoebner
authors.affiliation: Department of Plastic Surgery, Burns and Wound Healing, University of Montpellier, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Herlin
authors.affiliation: Infectious Disease Department, University Hospital of Nîmes, Place du Professeur Robert Debré, 30029, Nîmes Cedex 09, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lechiche
authors.affiliation: Institut of Systematic, Evolution and Biodiversity, UMR 7205 CNRS MNHN UPMC EPHE, National Museum of Natural History of Paris, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Rollard
authors.affiliation: Infectious Disease Department, University Hospital of Nîmes, Place du Professeur Robert Debré, 30029, Nîmes Cedex 09, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Laureillard
authors.affiliation: Infectious Disease Department, University Hospital of Nîmes, Place du Professeur Robert Debré, 30029, Nîmes Cedex 09, France. albert.sotto@chu-nimes.fr.
authors.forename: Albert
authors.initials: A
authors.lastname: Sotto
mesh_terms: D000328:Adult; D000818:Animals; D001247:Asthenia; D057210:Delayed Diagnosis; D005260:Female; D005602:France; D006801:Humans; D007871:Leg Ulcer; D009336:Necrosis; D010727:Phosphoric Diester Hydrolases; D001098:Spider Bites; D013111:Spider Venoms; D013112:Spiders; D013848:Thigh / Q000473:pathology*
chemical_list: D013111:Spider Venoms; C055161:loxosceles venom; D010727:Phosphoric Diester Hydrolases
keywords: Cutaneous loxoscelism; Loxosceles rufescens; Necrotic ulcer; Spider bite