A Case Diagnosed as Loxoscelism

Minegaki Yusuke, Tsujioka Kaoru, Ori Masahisa

The patient is 48-year-old Japanese woman who lives in Wakayama prefecture of Japan. While lying on the floor in her house in the afternoon on July, she felt slight pain on the flexural area of her left upper arm and noticed nearby a brown spider. About 4 hours later she had suffered by pain and swelling on the left upper arm. In spite of the treatment of a local physician which included administration of steroid and antibiotics, her symptoms did not subside and enforced her to visit our hospital on the 6th day. Our first examination revealed hemorrhagic plaque with induration and tenderness on her left upper arm surrounded by widespread edematous erythema on the left arm. The plaque became necrotic gradually, leaving well-circumscribed black necrotic lesion of 7×4cm size on the 20th day. It needed debridement and skin graft for healing. Because Loxosceles rufescens is confirmed to live in Wakayama prefecture and clinical course of the patient was supposed to be typical for necrotic cutaneous loxoscelism and there were no other plausible causes inducing such a skin lesion, we concluded that the patient was bitten by L.rufescens. This is the first reported case of loxoscelism in Japan.

A Case Diagnosed as Loxoscelism

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