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Therapeutic Plasma Exchange for Refractory Hemolysis After Brown Recluse Spider (Loxosceles reclusa) Envenomation

  • Toxicology Observation
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Abstract

Introduction

The brown recluse spider (BRS) (Loxosceles reclusa) envenomation can lead to multiple complications, including hemolysis. We present a case of refractory hemolysis after a BRS bite treated with therapeutic plasma exchange (TPE).

Case Report

A 17-year-old female presented with fever, fatigue, and dyspnea. She was diagnosed with sepsis and received intravenous (IV) fluids, inotropic support, and antibiotics. On hospital day 1 she was noted to have skin lesion consistent with a BRS bite and developed hemolysis. Systemic loxoscelism with hemolysis was then suspected and methylprednisolone IV was initiated. She was discharged with a stable HGB on hospital day 3 on oral prednisolone. She was re-admitted 24 h later, with signs of worsening hemolysis. Methylprednisolone was restarted and she was transfused 4 units of packed red blood cells. TPE was initiated due to the refractory hemolysis. Shortly after the TPE session, her clinical and laboratory status improved. She required no further transfusions and was discharged on a steroid taper.

Discussion

TPE is an extra-corporeal method to remove substances from the blood by separating plasma from cellular blood components and replacing it with physiologic fluids. TPE has been used for snake envenomation but there are no reports detailing its use for BRS envenomations. Improvement was associated with TPE initiation and may have been due to removal of complement components activated by the spider venom. This report suggests that TPE could be a possible treatment modality for systemic loxoscelism with refractory hemolysis due to BRS envenomation. Further investigation is warranted.

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References

  1. Gertsch WJ, Ennik F. The spider genus Loxosceles in North America, Central America, and the West Indies (Araneae, Loxoscelidae). Bull Am Mus Nat Hist. 1983;175:264–360.

    Google Scholar 

  2. Swanson DL, Vetter RS. Bites of brown recluse spiders and suspected necrotic arachnidism. N Engl J Med. 2005;352:700–7.

    Article  CAS  PubMed  Google Scholar 

  3. Rosen JL, Dumitru JK, Langley EW, Meade Olivier CA. Emergency department death from systemic loxoscelism. Ann Emerg Med. 2012;60:439–41.

    Article  PubMed  Google Scholar 

  4. Yildirim C, Bayraktaroğlu Z, Gunay N, Bozkurt S, Köse A, Yilmaz M. The use of therapeutic plasmapheresis in the treatment of poisoned and snake bite victims: an academic emergency department's experiences. J Clin Apher. 2006;21:219–23.

    Article  PubMed  Google Scholar 

  5. Gremski LH, Trevisan-Silva D, Ferrer VP, Matsubara FH, Meissner GO, Wille AC, et al. Recent advances in the understanding of brown spider venoms: From the biology of spiders to the molecular mechanisms of toxins. Toxicon. 2014;83:91–120.

    Article  CAS  PubMed  Google Scholar 

  6. Gehrie EA, Nian H, Young PP. Brown Recluse spider bite mediated hemolysis:clinical features, a possible role for complement inhibitor therapy, and reduced RBC surface glycophorin A as a potential biomarker of venom exposure. PLoS One. 2013;8:e76558.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Cacy J, Mold JW. The clinical characteristics of brown recluse spider bites treated by family physicians: an OKPRN Study. Oklahoma Physicians Research Network. J Fam Pract. 1999;48:536–42.

    CAS  PubMed  Google Scholar 

  8. Neuman G, Boodhan S, Wurman I, Koren G, Bitnun A, Kirby-Allen M, et al. Ceftriaxone-induced immune hemolytic anemia. Ann Pharmacother. 2014;48(12):1594–604.

    Article  PubMed  Google Scholar 

  9. Garratty G. Immune hemolytic anemia caused by drugs. Expert Opin Drug Saf. 2012;11(4):635–42.

    Article  CAS  PubMed  Google Scholar 

  10. Isbister GK. Data collection in clinical toxinology: debunking myths and developing diagnostic algorithms. J Toxicol Clin Toxicol. 2002;40(3):231–7.

    Article  PubMed  Google Scholar 

  11. Lowry J, Adam DA, Walters H, Wasserman G. Clinical and ancillary data in children with brown recluse spider envenomation. Clin Toxicol. 2011;49:517.

    Article  Google Scholar 

  12. Novak R, Mehesh Kumar AP, Thompson E, Billmeier GJ. Severe systemic toxicity from a spider bite in a six-year-old boy. J Tenn Med Assoc. 1979;72(2):110–1.

    CAS  PubMed  Google Scholar 

  13. WE N. Hemolytic anemia of necrotic arachnidism. Am J Med. 1961;31:801–7.

    Article  Google Scholar 

  14. McLeod B, Szczepiorkowski ZM, Weinstein R, Winters JL, editors. Apheresis: principles and practice. Bethesda, MD: AABB Press; 2010.

    Google Scholar 

  15. Ibrahim RB, Liu C, Cronin SM, Murphy BC, Cha R, Swerdlow P, et al. Drug removal by plasmapheresis: an evidence-based review. Pharmacotherapy. 2007;27(11):1529–49.

    Article  CAS  PubMed  Google Scholar 

  16. Hofmann G, Bauernhofer T, Krippl P, Lang-Loidolt D, Horn S, Goessler W, et al. Plasmapheresis reverses all side-effects of a cisplatin overdose—a case report and treatment recommendation. BMC Cancer. 2006;6:1.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Lane DR, Youse JS. Coombs-positive hemolytic anemia secondary to brown recluse spider bite: a review of the literature and discussion of treatment. Cutis. 2004;74:341–7.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Pediatric Resident, PGY 3, School of Medicine, University of Kansas, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS, 66160, USA

    Manjusha Abraham

  2. Department of Pathology and Laboratory Medicine, School of Medicine, University of Kansas, Kansas City, KS, USA

    Lowell Tilzer

  3. Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, University of Kansas, Kansas City, KS, USA

    K. Sarah Hoehn

  4. University of Kansas Hospital Poison Control Center, Kansas City, KS, USA

    Stephen L. Thornton

  5. Department of Emergency Medicine, University of Kansas Hospital, Kansas City, KS, USA

    Stephen L. Thornton

Authors
  1. Manjusha Abraham
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  2. Lowell Tilzer
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  3. K. Sarah Hoehn
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  4. Stephen L. Thornton
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Corresponding author

Correspondence to Manjusha Abraham.

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This paper has not previously been presented and was not funded.

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Abraham, M., Tilzer, L., Hoehn, K.S. et al. Therapeutic Plasma Exchange for Refractory Hemolysis After Brown Recluse Spider (Loxosceles reclusa) Envenomation. J. Med. Toxicol. 11, 364–367 (2015). https://doi.org/10.1007/s13181-015-0485-9

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  • DOI: https://doi.org/10.1007/s13181-015-0485-9

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