Weird Weekend Cases

[southerndoc]

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Over the past three days, I've had some weird cases:

- true Lemierre's disease
- Ramsay-Hunt Syndrome
- perforated carcinoid tumor
- botfly abscess in a traveler from Sierra Leone
- malignant otitis externa
- brown recluse spider bite

Cool stuff! Who says emergency medicine can be boring? 🙂

 

[NinerNiner999]

That sounds like a fun weekend. I also had a case of malignant otitis externa. I think my dairy anaphylaxis takes the cake - she was a 6-0 tube away from a cric!

 

[ERMudPhud]

- brown recluse spider bite

How sure are you of that one. New Haven is a long way from the nearest brown recluse and historically the bites are massively overdiagnosed. We have an ongoing problem in Colorado with every necrotic pimple, furuncle, or bug bite being called a recluse bite. This despite an ongoing unclaimed reward from the poison center for anyone who actually finds a recluse spide in Colorado.

http://dermatology.cdlib.org/DOJvol5num2/special/recluse.html

 

[margaritaboy]

How sure are you of that one. New Haven is a long way from the nearest brown recluse and historically the bites are massively overdiagnosed. We have an ongoing problem in Colorado with every necrotic pimple, furuncle, or bug bite being called a recluse bite. This despite an ongoing unclaimed reward from the poison center for anyone who actually finds a recluse spide in Colorado.

http://dermatology.cdlib.org/DOJvol5num2/special/recluse.html

We have the same problem down here. My theory: there are one or two very angry Brown Recluse spiders that have formed a posse and are responsible for all the bites in the greater Phoenix area.

 

[colforbinMD]

Ditto for Md. I was taught by our Poison Control Center that there has never been a documented case in Md nor a captured/ dead B.R. spider found in the wild BUT... get pts. complaining of it all the time. My favorite was a Poison Center call where the pt. KNEW for certain without a shadow of doubt that he has B.R. spiders in his shed and attic (he was in the military so he KNOWS what they look like) but then when we asked if his bite site was a blister he asked what a blister was. (Guess his branch of the military never gets blisters) I was told that the further south you are and the more wooded area the more likely you are to find B.R. spiders.

 

[Apollyon]

We have the same problem down here. My theory: there are one or two very angry Brown Recluse spiders that have formed a posse and are responsible for all the bites in the greater Phoenix area.

"Those two dudes" have branched out into arachnids, eh? And, of course, everyone bitten was just "minding their own business", sitting on the porch reading the bible with Grandma when this spider bit them for no reason.

 

[GeneralVeers]

"Those two dudes" have branched out into arachnids, eh? And, of course, everyone bitten was just "minding their own business", sitting on the porch reading the bible with Grandma when this spider bit them for no reason.

All the patients claim to have a "spider bite", but many of them won't admit to (or don't want to think about) the fleas they have on their clothes and bodies.

 

[southerndoc]

How sure are you of that one. New Haven is a long way from the nearest brown recluse and historically the bites are massively overdiagnosed. We have an ongoing problem in Colorado with every necrotic pimple, furuncle, or bug bite being called a recluse bite. This despite an ongoing unclaimed reward from the poison center for anyone who actually finds a recluse spide in Colorado.

http://dermatology.cdlib.org/DOJvol5num2/special/recluse.html

Not completely certain, but fairly certain considering the guy was an arachnid specialist (technical term?) who recently returned from a trip to South Carolina. He said it was a brown recluse.

It actually didn't appear necrotic (he said it was early), and it didn't resemble the brown recluse spider bites I've seen before as a medical student in the South, where they are found more than in the New England area.

Remember, just because brown recluses aren't found in a certain area doesn't mean a person can't suffer from one if they have recently travelled (hitched a ride in a suitcase).

 

[bulgethetwine]

One anecdote: As a medical student I was adopting already the somewhat cynical air of scepticism toward spider bites just from the heresay. I finally got my own pt who claimed to have been bitten, and in my cocksure way, asked him "Did you actually see the spider or by chance bring it in?"

Expecting him to sputter and spit some excuse, you can imagine my surprise when he said "Yup!" and proceeded to produce a plastic bag with an only partially smushed small, black spider with a clear rose/orange hourglass on the belly....

It was fun when I got to play the same game with my attending that night.... 😀

 

[ekydrd]

...small, black spider with a clear rose/orange hourglass on the belly....

That would be a black widow spider... not a brown recluse. Still a nasty little beasty tho.

 

[ISU_Steve]

One of my professors is an entomologist and he had a call over the weekend for a person bitten by a "carrion beetle". According to him, the ER resident asked him if it was poisonous and how to treat the bite. Being the grandious smartass he is, Ken told him to dose the patient up with pain drugs because there was no known antidote for the bite of this bug. What is truly sad is that he apparently had the resident believing this for several minutes before he could no longer keep from laughing at the guy.