CLINICAL PRESENTATION AND OUTCOME OF BROWN RECLUSE SPIDER BITE

Study objective: To examine the clinical presentation and outcome of p atients treated in the ED or toxicology clinic for suspected brown rec luse spider bites. Methods: We assembled a retrospective case series o f patients at a southeastern US university hospital. Our study group c omprised 111 patients with suspected brown recluse spider bites treate d during a 30-month period. Our main outcome measures were the need fo r skin grafting and the development of other complications. Results: T he mean age of our subjects was 34+/-17 years. Thirteen patients (12%) brought the spider to the hospital, 22 (20%) saw a spider at the time of the bite, and an exclusively clinical diagnosis was made in the re maining 76 (68%). Most wounds (59%) involved the leg. At the time of p resentation, 81% had central discoloration and 37% necrosis. Sixteen p atients (14%) were systemically ill, acid 6 (5%) were admitted to the hospital. Most (86%) were treated with antibiotics. Dapsone was infreq uently used (9%) and had usually been prescribed before the patient's presentation to our ED. Only three patients (3%; 95% confidence interv al, 1% to 8%) required skin grafting. Mild hemolytic anemia developed in one patient, and another had mild hemolysis and a mild coagulopathy ; neither patient was taking dapsone. No deaths or serious complicatio ns occurred in our study group. Conclusion: In our series, long-term o utcome after brown recluse spider bite was good. Serious complications were rare, as was the need for skin grafting. Because the vast majori ty of bites heal with supportive care alone, aggressive medical therap y does not appear warranted.