3-year-old girl was admitted for sudden onset of 12 hours of high fever, vomiting, malaise, and skin rash the day prior to admission, with no history of trauma or drugs. The patient showed a petechial and morbilliform rash, swelling, redness and a dry dark blue-purple lesion on the right big toe (Figure). Blood tests showed thrombocytopenia (18 10 9 /L), high C-reactive protein, and no signs of disseminated intravascular coagulation. A presumptive diagnosis of loxoscelism was made, based on the clinical picture in an endemic area during the warm season. The patient was treated with antibiotics until blood and wound cultures appeared negative and prednisone for 5 days, and was discharged after 4 days with resolution of the systemic symptoms and laboratory improvement. The dermonecrosis underwent desquamation and healing within 3 weeks. Loxoscelism describes the reactions and lesions caused by bites from spiders of the genus Loxosceles. 1-3 In Israel, certified bites of L rufescens have been reported and many cases of loxoscelism have been described. 1,4 Most bites are benign, but local and/or systemic reactions can appear. The typical local manifestation is dermonecrosis. Systemic symptoms include morbilliform rash, fever, chills, nausea, vomiting, malaise, arthralgia, and myalgia; hemolytic anemia and leukocytosis; less frequent thrombocytopenia, disseminated intravascular coagulation, renal failure, multiorgan failure, and even death, more commonly in children than in adults. 1-3 Loxosceles venom contains enzymes (hyaluronidase, alkaline phosphatase, esterase, and sphingomyelinase D2) responsible for tissue destruction and cytotoxicity. 1-3 The diagnosis is rarely based on identification of the spider. A presumptive diagnosis is made clinically, based on