Does Black widow spider envenomation cause quadriplegia

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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TOXICOLOGY15_152

تاریخ نمایه سازی: 15 بهمن 1398

Abstract:

Introduction:Black widow spider (BWS) is one of the most poisonous spiders around the world. In this report we present a case with quadriplegia after BWS envenomation as the first report in literature.Case Report: A 42-year-old man was admitted in clinical toxicology department, Imam Reza (p) hospital suspicious to spider bite in his left forearm. He was awake, agitated and febrile complaining generalized muscle cramps. Shivering, considerable sweating and severe abdominal pain were other detected signs and symptoms. A very little puncture mark was seen in bite site. Surgery consult was performed and acute surgical abdomen was rolled out. The patient was intubated and underwent mechanical ventilation due to respiratory failure on day 2 after admission. He also suffered weakness in upper and lower limbs before intubation. About 3 weeks after admission, whereas the general condition gradually improved, he was extubated and sedative medications were discontinued, the only remained problem was quadriplegia! Blood lead level was 11 μgr /dL. Urine test for Arsenic and Thallium were negative. Rheumatology disorders was rolled out after rheumatology consult. EMG and NCV reported myopathy, as well as severe sensory motor polyneuropathy. Neurology consult was performed and initial neurologic problem was rolled out. The patient s weakness gradually recovered, eventually 45 days after admission, He was able to walk with help and was discharged with recommendation to continue physical exercise and physiotherapy and subsequent follow-up visits.Discussion and conclusion: Generalized Muscle cramp, back pain, abdominal pain (that sometimes mimic acute abdomen), severe sweating and shivering are the expected clinical findings of BWS envenomation. Four-limb paralysis in current report has not yet been reported in literature. The suggested differential diagnosis were neurologic problems (such as Guillain Barre), tick bite paralysis, funnel web spider (FWS) envenomation, metal poisoning (lead in particular); all of which were evaluated and rolled out. Given that no causative item was found other than spider bite for four-limb paralysis and its generalized weakness, this condition was considered a possible rare complication of BWS bite. This report highlights the need for more extensive studies in this area.

Authors

Bita Dadpour

Medical Toxicology Research Center, School of medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Helia Farham

Medical Toxicology Research Center, School of medicine, Mashhad University of Medical Sciences, Mashhad, Iran