Systemic loxoscelism can develop 24 to 72 hours after a bite, resulting in hemolysis, rhabdomyolysis, and even disseminated intravascular coagulation (DIC). Pediatric patients are most susceptible to systemic loxoscelism, and urinalysis is a useful screening lab that can identify hemolysis early in the course of a systemic reaction. Given hematuria on urinalysis and severe pain, this patient was admitted for further observation and care.
Her fibrinogen level, haptoglobin, and lactic acid dehydrogenase (LDH) were all within normal limits and hemoglobin/hematocrit remained stable over her hospital course. Based on these collective findings, the hematuria was hypothesized to have been a contaminant from her current menstrual cycle. Nonetheless, systemic loxoscelism can be a true emergency requiring multiple transfusions and carries a high risk of death if not promptly recognized or respected.
The ultimate clinical care of brown recluse bites includes ice, elevation of the affected limb (if practical), and tetanus vaccine booster. A myriad of additional therapies, such as dapsone, have been proposed as treatment modalities. No randomized control trials, however, have demonstrated their efficacy or improved patient outcomes.