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An 8 year old boy caught a spider, placed it in a jar, and was showing it to his friend when he was bit on the hand. Initially he had minimal pain but now, 1 hour later, has significant hand and arm pain and he has vomited a few times. On physical exam, the wound site is a blanched rounded patch with central punctum, and palpation of extremity reveals muscle rigidity when compared to the other side.
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September 16, 2020 at 12:21 am
C) This envenomation may be misdiagnosed as acute appendicitis
The description is most consistent with a black widow spider envenomation. Brown recluse spiders, the other major serious spider envenomation in North America, are reclusive and unlikely to be caught. Widow spiders are frequently encountered outdoors. Initially the bite appears targetoid and causes no to minimal pain, but muscle pain is a prominent symptom, typically developing in 30min – 2 hours. Severe abdominal pain and muscular rigidity may be mistaken for acute abdomen. Treatment is supportive and symptoms abate over 24-72 hours, but antivenom is available for life-threatening symptoms (consult a toxicologist). The other answers are true for brown recluse spider bites.