To the Editor: Dr Freedman and colleagues1 detailed the clinical course of a 7-month-old infant
with cutaneous anthrax. However, I find it disturbing that the working diagnosis,
which remained preeminent until hospital day 12, was cutaneous and systemic
loxoscelism (ie, recluse spider envenomation). Physicians and patients often
ascribe otherwise unexplained skin lesions to Loxosceles
reclusa or other spider envenomations with little if any supporting
Brown recluse spider bites essentially never occur outside this species' natural
geographic range in the south central United States, where they are generally
not regarded as a medical calamity,3 as
typical of nonendemic regions. It is exceedingly unlikely that someone in
the Manhattan area could be envenomated by a brown recluse spider. Without
observing either the bite or a spider, the chance that this child (or anyone
in a nonendemic area) had cutaneous or systemic loxoscelism was essentially
nil, even if the clinical features appeared consistent. Furthermore, assigning
the diagnosis of loxoscelism served no useful purpose, because supportive
care alone is the mainstay of treatment for brown recluse spider envenomation.
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