Dermonecrotic loxoscelism in the Mediterranean region

Publications on loxosceles spider bites in the Mediterranean region are sca rce. This spider is frequently found in Israel and its bite may cause sever e medical problem. We report on 11 patients who sustained such bites and re quired hospitalization between 1988 and 1997 in a regional hospital serving a population of 300,000. Most of them were bitten in the summer, 10 on the medial aspect of the arm or thigh. All patients exhibited the typical loxo sceles skin lesion; systemic manifestations were evident in six. Seven pati ents were misdiagnosed. All were treated with antibiotics and eight with th e addition of corticosteroids. Ten patients fully recovered within 2-3 week s. The estimated incidence of severe dermonecrotic loxoscelism requiring hospi talization is 0.37 cases/100,000 population/year. It seems that the clinica l course in our cases was somewhat milder than in other reported cases from the United States. This can possibly be attributed to the bite of Loxoscel es rufescens, which is the prevailing species in this region. In conclusion , this clinical entity is common and frequently misdiagnosed. Appropriate d iagnosis requires awareness of and alertness to loxosceles bite.