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Case report
P-ANCA vasculitis with diffuse alveolar haemorrhage preceded by a spider bite
  1. Ali Hameed Ali1,
  2. Mandip Singh Kang1,
  3. Jaafar Aldahwi2 and
  4. Candice Reyes3
  1. 1Internal Medicine, UCSF, Fresno, California, USA
  2. 2VA Medical Center Fresno, Fresno, California, USA
  3. 3Internal Medicine, UCSF Fresno Center for Medical Education and Research Edward and Ann Hildebrand Medical Library, Fresno, California, USA
  1. Correspondence to Dr Mandip Singh Kang; MKang{at}


We report a patient with antineutrophilic cytoplasmic antibody (ANCA) vasculitis that was preceded by witnessed black widow spider bites. The patient initially presented with a diffuse painful skin rash that developed after a few hours post bite. He was treated initially with topical ointment for the suspected bite. However, subsequently a few days later the patient returned to the hospital with similar, but more progressive rash with haemoptysis and acute hypoxic respiratory failure requiring supplemental oxygen. Immunology work up showed elevated titre of peri-nuclear ANCA. Bronchoscopy revealed diffuse alveolar haemorrhage. The patient was treated successfully with methylprednisolone and rituximab.

  • vasculitis
  • dermatological

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  • Contributors AHA and MSK were the primary and secondary resident physicians, respectively, on the medicine ward service taking care of the patient. AHA and MSK both gathered the data and constructed the case report in writing under the supervision of JA. CR provided speciality consulting in rheumatology for the patient and educated both AHA and MSK in terms of diagnosis and pathogenesis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.