Abstract
Background
Black widow spider (Latrodectus spp) envenomation represents the most medically significant spider envenomation in
the United States, prompting more than 2500 calls to poison centers annually. The
female spider, which is responsible for symptomatic envenomations, is classically
described as a shiny black spider with a red hourglass-shaped marking on the ventral
abdomen. Clinical features of envenomation include painful muscle cramping, abdominal
pain, and autonomic disturbances, such as tachycardia, hypertension, and diaphoresis.
“Latrodectus facies” or “facies latrodectismica” is an additional distinctive but rarely described
clinical finding characterized by periorbital edema, lacrimation, and blepharospasm.
Case Report
A 6-year-old female developed the typical clinical features of Latrodectus envenomation after being found in bed with a Western black widow spider (Latrodectus hesperus) with no ventral marking. She initially improved with opioid analgesia, but 6 h later
her symptoms worsened again, and concurrent with this worsening she developed Latrodectus facies. She received additional opioid analgesia and all her symptoms resolved within
24 h. Her mother provided informed and written consent for the acquisition and publication
of the facial photographs presented.
Why Should an Emergency Physician Be Aware of This?
A high degree of clinical suspicion is necessary to correctly diagnose Latrodectus envenomation, especially when the spider escapes unnoticed or in young children in
whom the bite is not witnessed. To our knowledge, Latrodectus facies has not been reported previously in a young child, and recognition of this
finding will aid clinicians in limiting unnecessary interventions and administering
appropriate therapy.
Keywords
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References
- A US perspective of symptomatic Latrodectus spp envenomation and treatment: a national poison data system review.Ann Pharmacother. 2011; 45: 1491-1498
- Recent advances in research on widow spider venoms and toxins.Toxins. 2015; 7: 5055-5067
- Latrodectism: variations in clinical manifestations provoked by Latrodectus species of spiders.Toxicon. 1983; 21: 457-466
- Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases.Ann Emerg Med. 1992; 21: 782-787
- Edema palpebral severo en latrodectismo.Bol Soc Peruana Med Intern. 1996; 9: 154-156
- A randomized, double-blind, placebo-controlled trial of a highly purified equine F(ab)2 antibody black widow spider antivenom.Ann Emerg Med. 2013; 61: 458-467
- Antivenom treatment in arachnidism.J Toxicol Clin Toxicol. 2003; 41: 291-300
- Anaphylaxis with Latrodectus antivenin resulting in cardiac arrest.J Med Toxicol. 2011; 7: 317-321
- Anaphylaxis to black widow spider antivenom.Am J Emerg Med. 2012; 30: 836.e1-836.e2
Article info
Publication history
Published online: September 03, 2019
Accepted:
June 15,
2019
Received in revised form:
June 4,
2019
Received:
April 7,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
