Loxosceles reclusa (Brown Recluse) Bite Photos

[Nightshady]

In hospitals many things get blamed to be brown recluse bites that are not (most famously being IV drug-use infections). This is a verified brown recluse bite in a patient I’m seeing. First pic was at presentation; pretty classic IME for a recluse bite with the central necrosis and surrounding semi-necrosis and inflammation. Second pic is about a week after the necrotic tissue was debrided and wound care initiated. Thought y’all would find this interesting. Pictures posted with permission.

 

[Wesley Smith]

This is like a train wreck, I want to look but every time I see it I almost vomit.

 

[BoyFromLA]

Ouch...

 

[Mirandarachnid]

Where is the bite located?

 

[The Snark]

How long between incipient incident and the first pic? That's doesn't appear to be healthy tissue is the second picture. Any follow up pics with time frame? Is that full subdermal in the meatus? Was that only debridment without surgical intervention? I'm no dermatologist and thusly, curios.

 

[Chris LXXIX]

When in Italy someone tells me (or, better, I hear that in public areas, Bars etc) that a 'ragno violino' (brown recluse) spider 'bitten me' I reply in no time that '... I'm a breeder of those, my house is full' and start to talk about the joy of caring for a L.reclusa

 

[pannaking22]

Interesting to see a confirmed (presumably they brought in the spider?) Loxo bite that was fully necrotic. Thanks for sharing!

 

[Nightshady]

Where is the bite located?

It’s on the thigh.

 

[Nightshady]

How long between incipient incident and the first pic? That's doesn't appear to be healthy tissue is the second picture. Any follow up pics with time frame? Is that full subdermal in the meatus? Was that only debridment without surgical intervention? I'm no dermatologist and thusly, curios.

First pic was initial presentation. Did some minor debridement and started dressing care. Patient came back the next week and the necrosis had stopped but there was still some necrotic tissue remaining so did another debridement. Patient came back a week later and that’s the second pic. Wound will probably be filled in within a week or two. Ideally patient should get a skin graft but she has no insurance so probably will just let it re-epithelialize naturally. End result will be more or less the same, but it will just take longer.

 

[Nightshady]

Interesting to see a confirmed (presumably they brought in the spider?) Loxo bite that was fully necrotic. Thanks for sharing!

Patient actually saw the spider and believed it to be a recluse. It’s kind of rare that someone actually ID’s the spider because most recluse bites are initially painless. The reaction and presentation is basically textbook for a recluse bite, so given the spider was ID’d and given the presentation I’m 100% sure of the diagnosis.

 

[basin79]

Patient actually saw the spider and believed it to be a recluse. It’s kind of rare that someone actually ID’s the spider because most recluse bites are initially painless. The reaction and presentation is basically textbook for a recluse bite, so given the spider was ID’d and given the presentation I’m 100% sure of the diagnosis.

What would happen if medical intervention wasn't possible? Would the body heal itself or would an ulcer or abscess form? Thanks for posting the pictures. I love anything like this.

 

[Ghost56]

What would happen if medical intervention wasn't possible? Would the body heal itself or would an ulcer or abscess form? Thanks for posting the pictures. I love anything like this.

I'm not a doctor or anything but I would think with some self treatment, healing would be possible without medical attention. If you just left it alone and didn't remove the necrotic tissue or anything, I would think gangrene or something along those lines could develop.

 

[Nightshady]

What would happen if medical intervention wasn't possible? Would the body heal itself or would an ulcer or abscess form? Thanks for posting the pictures. I love anything like this.

If the necrotic material wasn’t removed, bacteria could flourish and cause a severe infection with more tissue necrosis and a vicious cycle could start. Conversely, if the necrotic tissue was dessicated (dry gangrene), it might just rot off without that bad scenario playing out. Wet necrotic tissue is ripe for bacteria, but dried-out necrotic tissue is usually safe.

 

[Nightshady]

I'm not a doctor or anything but I would think with some self treatment, healing would be possible without medical attention. If you just left it alone and didn't remove the necrotic tissue or anything, I would think gangrene or something along those lines could develop.

Yeah that’s basically correct.

 

[dangerforceidle]

Patient actually saw the spider and believed it to be a recluse. It’s kind of rare that someone actually ID’s the spider because most recluse bites are initially painless. The reaction and presentation is basically textbook for a recluse bite, so given the spider was ID’d and given the presentation I’m 100% sure of the diagnosis.

I wouldn't trust an average person's ability to correctly identify a spider. At least you're actually in range, unlike bites that are medically diagnosed in California and NY State.

 

[Nightshady]

I wouldn't trust an average person's ability to correctly identify a spider. At least you're actually in range, unlike bites that are medically diagnosed in California and NY State.

Many people raised in Texas are taught how to identify them, as they are fairly common although bites are rare. You do have a valid point though, but in this case where they say “a spider I think was a brown recluse but me here” and they have a wound like that... it’s a no-brainer.

 

[The Snark]

It goes down as a 'probable' Recluse. Same as child was playing in sewage and infection is gram negative: probable E-coli.

 

[Veles]

Jesus christ, these are harrible.
And i though hornet stings and centipede bites were bad.

 

[Nightshady]

It goes down as a 'probable' Recluse. Same as child was playing in sewage and infection is gram negative: probable E-coli.

LOL... OK.

Patient comes to ER.

Subjective - Patient says they have been shot.

Exam - hypotensive; small bleeding hole anterior abdomen, slightly larger bleeding hole posterior abdomen

Diagnosis - probable GSW

 

[The Snark]

@Nightshady Fortunately, or unfortunately, that's how medicine works. Since you seems to be in medical circles, you know physicians will never reach a concrete diagnosis without corroborating facts. Reminiscent, evocative, similar, implicative, recollective, indicative, suggestive, characteristic and on and on.
That's why, when we hear someone with a bite of some sort reporting the ER physician diagnosed a spider bite it's highly suspect from word go, bullfeathers or possible a PoD woke from sleep after pulling an 18 hour shift. Your example typifies, suspected through and through foreign object penetration. Surgery and MRI reveals characteristics of high speed ballistic projectile. Diagnosis will be probable gunshot wound unless the projectile is found and a lab establishes it was the penetrating object and forensic evidence corroborates.

For paramedics in particular, this can be extremely frustrating. They can see a vehicle roll over a patient but come the ER it will go down as 'suspected' massive blunt trauma.