Ultrasonography for early detection of non‐infectious necrotizing fasciitis secondary to cutaneous loxoscelism

Abstract

A 50‐year‐old woman consulted to the emergency department for painful erythematous swelling on her forearm hours after a spider bite. The patient had spent the evening cleaning the outside of her home, located in the periphery of an urban area, next to a ravine, on the western Mediterranean Basin, when she identified a spider on the dorsum of her forearm. She described it as a light‐brown coloured spider, with darker long legs, between 1 and 1,5 cm in size. Though she felt no pain she brushed off the spider and it scared away. Hours later she began feeling pain on that same forearm. She had no systemic symptoms. Physical examination revealed an erythematoedematous plaque on her forearm. Blood work revealed leukocytosis (13 x10⁹/L) and neutrophilia (81,3%). Cultures from blood and skin were taken. The patient was diagnosed with cellulitis versus suspected CL and admitted for intravenous antibiotic and non‐steroidal antiinflamatory therapy.

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