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Acute necrotic arachnidism with necrotising fasciitis and recurrent pneumothorax
  1. Jasleen Duggal1,
  2. Swathi Sunil Rao2 and
  3. Shiva Kumar Reddy1
  1. 1Paediatrics, Nitte(Deemed to be University), KS Hegde Medical Academy, Mangalore, Karnataka, India
  2. 2Pediatrics, Nitte(Deemed to be University), KS Hegde Medical Academy, Mangalore, Karnataka, India
  1. Correspondence to Dr Swathi Sunil Rao; swathirao{at}


A male infant presented with swelling of the left leg and fever. Over the next 2 days, the area developed fasciitis extending to the left thigh, abdomen, and lower chest. Meanwhile, the parents found a giant brown spider within the infant’s cot belonging to the genus Loxosceles, otherwise called the brown recluse spider. The dermo-myonecrosis progressed to deeper tissues involving the lung parenchyma requiring invasive ventilation. CT of the thorax showed multiple pneumatoceles, and lung biopsy showed alveolar necrosis. The infant was treated with intravenous antibiotics and corticosteroids. We drained the pneumothoraces by thoracostomy and insertion of intercostal drainage tubes. The infant required respiratory support initially by conventional ventilation, which was escalated to high-frequency oscillatory ventilation. He had refractory hypoxaemia and died. This is the first fatal case of acute spider envenomation described in India. Spider envenomation must be considered in patients with sudden onset, rapidly progressive necrotising fasciitis unresponsive to antibiotic therapy.

  • Air leaks
  • Paediatric intensive care
  • Mechanical ventilation
  • Dermatological

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  • Contributors SSR and SKR were the primary physicians involved in the management of the patient and contributed in the preparation of the manuscript. JD has contributed for manuscript writing, literature review and discussion.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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