[Cutaneous loxoscelism, about an exceptional observation of 9 consecutive cases].
BACKGROUND
Loxosceles spiders are ubiquitous and responsible for many cases of envenomation in the world. The kind rufescens is present in the Provence and Occitan regions in France. During the summer 2015, we faced many Loxosceles rufescens cases of bites having led to extensive integumental necrosis whose features and singular evolution seems important to report.


METHODS
We report the cases of nine patients who experienced a spider bite in the summer of 2015 in the Languedoc Roussillon.


RESULTS
Of nine patients, eight patients had skin necrosis and five required surgical care. Five patients had a fever and had five other general signs such as important asthenia, joint pain, nausea and dizziness. CRP was very low normal in all patients. Finally, five of the nine patients reported a residual pain.


CONCLUSIONS
L. rufescens is a small spider (7 to 15mm in diameter) having a cytotoxic venom. Loxoscelism diagnosis is usually made by removing a front necrotic skin lesion. Of systemic loxoscelism that have been described, some American species had fatal outcomes. The treatment remains controversial with various options: surgery, antibiotics, antihistaminics, antivenom.


CONCLUSIONS
The diagnosis must be made in endemic areas when confronted to a necrosic integumentary infectious rapidly progressive, unresponsive to antibiotic treatment associated with atypical general signs.
Département de chirurgie plastique et reconstructrice, CHRU Lapeyronie, 34295 Montpellier, France; Centre de traitement des brûlés, CHRU Lapeyronie, 34295 Montpellier, France; Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France.
F
F
Boissiere
Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France.
R
R
Masson
Département de chirurgie plastique et reconstructrice, CHRU Lapeyronie, 34295 Montpellier, France; Centre de traitement des brûlés, CHRU Lapeyronie, 34295 Montpellier, France; Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France.
S
S
Fluieraru
Département de chirurgie plastique et reconstructrice, CHRU Lapeyronie, 34295 Montpellier, France; Centre de traitement des brûlés, CHRU Lapeyronie, 34295 Montpellier, France; Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France.
J
J
Vitse
Département de chirurgie plastique et reconstructrice, CHRU Lapeyronie, 34295 Montpellier, France; Centre de traitement des brûlés, CHRU Lapeyronie, 34295 Montpellier, France; Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France.
L
L
Dessena
Département de chirurgie plastique et reconstructrice, CHRU Lapeyronie, 34295 Montpellier, France; Centre de traitement des brûlés, CHRU Lapeyronie, 34295 Montpellier, France; Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France.
M
M
Lefevre
Département de chirurgie plastique et reconstructrice, CHRU Lapeyronie, 34295 Montpellier, France; Centre de traitement des brûlés, CHRU Lapeyronie, 34295 Montpellier, France; Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France; Unité de chirurgie plastique et craniofaciale pédiatrique, CHRU Lapeyronie, 34295 Montpellier, France.
F
F
Bekara
Département de chirurgie plastique et reconstructrice, CHRU Lapeyronie, 34295 Montpellier, France; Centre de traitement des brûlés, CHRU Lapeyronie, 34295 Montpellier, France; Unité médico-chirurgicale de plaies et cicatrisation, CHRU Picardie, 34295 Amiens, France; Unité de chirurgie plastique et craniofaciale pédiatrique, CHRU Lapeyronie, 34295 Montpellier, France. Electronic address: drchristianherlin@gmail.com.
C
C
Herlin
D000328:Adult; D000818:Animals; D063287:Brown Recluse Spider; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D012867:Skin / Q000473:pathology*; D001098:Spider Bites / Q000150:complications*; D055815:Young Adult
Araignées; Bites; Loxosceles; Morsure; Necrosis; Nécrose; Spider; Toxin; Toxine; Venin; Venom