Mediterranean recluse bite necroses cartilage

Short case report from the Netherlands today. It involves a 22 year old woman who went to Italy on vacation, and one night woke up with left ear pain. This progressed to a small vesicle, then to swelling of the entire left side of her face. She was given antihistamines, but 2 days later had continued edema, worsening ear pain and a rash of her entire body. She also developed the characteristic red, white, and blue discoloration of her ear at that time. She was given higher doses of antihistamines, but no other treatment per the report. She developed necrosis by day 12.

Once she returned home, she went to a plastic surgery clinic where she received a partial ear reconstruction using costal cartilage and a full thickness graft. The authors wrote the case up as the first documented instance of cartilage necrosis due to (presumed) recluse bite.

The report then does a good job of describing proper recognition and treatment of brown recluse bites. Pretty decent write-up and excellent figures by the Journal of Plastic, Reconstructive & Aesthetic Surgery.

Holtslag I, van Wijk M, Kon M. Partial ear necrosis due to recluse spider bite. J Plast Reconstr Aesthet Surg. 2014 Mar;67(3):419-21. [PMID 24183057]

Further Reading

• Hensley J. Brown Recluse bites. EBM Going Wild