Le loxoscelisme cutané, à propos d’une observation exceptionnelle de 9 cas consécutifs

Abstract

Loxosceles spiders are ubiquitous and responsible for many cases of envenomation in the world. The kind rufescens is present in the Provence and Occitan regions in France. During the summer 2015, we faced many Loxoscelesrufescens cases of bites having led to extensive integumental necrosis whose features and singular evolution seems important to report. We report the cases of nine patients who experienced a spider bite in the summer of 2015 in the Languedoc Roussillon. Of nine patients, eight patients had skin necrosis and five required surgical care. Five patients had a fever and had five other general signs such as important asthenia, joint pain, nausea and dizziness. CRP was very low normal in all patients. Finally, five of the nine patients reported a residual pain. L.rufescens is a small spider (7 to 15mm in diameter) having a cytotoxic venom. Loxoscelism diagnosis is usually made by removing a front necrotic skin lesion. Of systemic loxoscelism that have been described, some American species had fatal outcomes. The treatment remains controversial with various options: surgery, antibiotics, antihistaminics, antivenom. The diagnosis must be made in endemic areas when confronted to a necrosic integumentary infectious rapidly progressive, unresponsive to antibiotic treatment associated with atypical general signs.