PMID- 31685322
OWN - NLM
STAT- MEDLINE
DCOM- 20200206
LR  - 20200206
IS  - 1545-1534 (Electronic)
IS  - 1080-6032 (Linking)
VI  - 30
IP  - 4
DP  - 2019 Dec
TI  - Heightened Immune Response to Presumed Loxosceles reclusa Envenomation.
PG  - 450-453
LID - S1080-6032(19)30124-3 [pii]
LID - 10.1016/j.wem.2019.06.014 [doi]
AB  - Loxoscelism is a systemic inflammatory reaction in response to a brown recluse 
      spider bite (BRSB). In this case we describe a patient with a heightened 
      inflammatory response to a presumed BRSB, with Coomb's positive hemolysis, 
      cytoplasmic antineutrophil cytoplasmic antibody (cANCA) vasculitis, and features 
      of hemophagocytic lymphohistiocytosis (HLH). A 24-y-old female presented with 
      sudden pain and swelling to her lower back, nausea, fever, and tachycardia after 
      a presumed BRSB. Hemolysis began on hospital day 3 (15.9 g.dL(-1)) with a nadir 
      on hospital day 5 (6.3 g.dL(-1)). She had an lactate dehydrogenase of 1415 
      U.L(-1), ferritin of 15534 ng.mL(-1), persistent fever, and signs of bone marrow 
      suppression despite hemolysis, with thrombocytopenia (100,000 muL(-1)) and an 
      inadequate reticulocyte response (1.7%) suggestive of HLH. The patient's blood 
      was Coomb's and cANCA/antiproteinase 3 positive. She had signs of toxin-induced 
      vasculitis, with respiratory failure requiring bilevel positive airway pressure, 
      radiographs with bilateral pulmonary infiltrates, and a desquamating rash. She 
      received 6 U of packed red blood cells, furosemide for pleural and pericardial 
      effusions, antibiotics, and symptomatic treatment during the acute phase of her 
      illness. Hemolysis improved without glucocorticoids by hospital day 6. The 
      patient demonstrated a dysregulated immunologic and complement-mediated response 
      to the presumed BRSB. The triad of Coomb's positive hemolysis, cANCA vasculitis, 
      and HLH-like reaction associated with a presumed BRSB is described for the first 
      time in the literature and brings up questions for future research regarding the 
      role of immune modulators and complement inhibitors in the treatment of severe 
      loxoscelism as well as the genetic factors that predispose certain individuals to 
      such reactions.
CI  - Copyright (c) 2019 Marketing EDGE.org. Published by Elsevier Inc. All rights 
      reserved.
FAU - Schmid, Kristin M
AU  - Schmid KM
AD  - Division of Emergency Medicine, Saint Louis University School of Medicine, St. 
      Louis, MO. Electronic address: kschmid@salud.unm.edu.
FAU - Treaster, Matthew R
AU  - Treaster MR
AD  - Division of Emergency Medicine, Saint Louis University School of Medicine, St. 
      Louis, MO.
FAU - Barrios, Christopher
AU  - Barrios C
AD  - Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University 
      School of Medicine, St. Louis, MO.
FAU - Zhang, Chenchen
AU  - Zhang C
AD  - Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University 
      School of Medicine, St. Louis, MO.
FAU - Scalzo, Anthony J
AU  - Scalzo AJ
AD  - Division of Emergency Medicine, Saint Louis University School of Medicine, St. 
      Louis, MO; Division of Toxicology, Saint Louis University School of Medicine, St. 
      Louis, MO; Division of Pediatrics, Saint Louis University School of Medicine, St. 
      Louis, MO.
LA  - eng
PT  - Journal Article
DEP - 20191102
PL  - United States
TA  - Wilderness Environ Med
JT  - Wilderness & environmental medicine
JID - 9505185
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Diuretics)
RN  - 0 (Spider Venoms)
RN  - 7LXU5N7ZO5 (Furosemide)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Animals
MH  - Anti-Bacterial Agents
MH  - *Brown Recluse Spider
MH  - Diuretics/therapeutic use
MH  - Erythrocyte Transfusion
MH  - Furosemide/therapeutic use
MH  - Humans
MH  - Oxygen/therapeutic use
MH  - Spider Bites/*immunology/*pathology/therapy
MH  - Spider Venoms
MH  - Young Adult
OTO - NOTNLM
OT  - hematology
OT  - resuscitation
OT  - spider bite
OT  - toxicology
EDAT- 2019/11/07 06:00
MHDA- 2020/02/07 06:00
CRDT- 2019/11/06 06:00
PHST- 2018/11/27 00:00 [received]
PHST- 2019/06/15 00:00 [revised]
PHST- 2019/06/21 00:00 [accepted]
PHST- 2019/11/07 06:00 [pubmed]
PHST- 2020/02/07 06:00 [medline]
PHST- 2019/11/06 06:00 [entrez]
AID - S1080-6032(19)30124-3 [pii]
AID - 10.1016/j.wem.2019.06.014 [doi]
PST - ppublish
SO  - Wilderness Environ Med. 2019 Dec;30(4):450-453. doi: 10.1016/j.wem.2019.06.014. 
      Epub 2019 Nov 2.