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Medicina interna de México
versión impresa ISSN 0186-4866
Resumen
MORANCHEL-GARCIA, L et al. Clinical evolution of patients with systemic and dermonecrotic loxoscelism in a third level hospital. Med. interna Méx. [online]. 2017, vol.33, n.1, pp.18-27. ISSN 0186-4866.
BACKGROUND:
Loxoscelism is a poisoning caused by the bite of Loxosceles recluse spider, whose venom contains sphingomyelinaseD, causing hemolysis and necrosis. We report a case series describing their clinical course and response to treatment.
OBJECTIVE:
To describe the evolution and clinical characteristics of patients with systemic and dermonecrotic loxoscelism, their response to treatment and complications.
PATIENTS AND METHOD:
A descriptive analysis of patients treated in the Internal Medicine Service, Centro Médico Nacional La Raza, from 2010 to 2015.
RESULTS:
A total of 8 men (67%) and 4 women (33%) were included. Mean age was 39.4 years (16-83 years). Bite site was left pelvic limb in 5 cases (42%), 4 in the right forelimb (33%), 2 in the face (17%) and 1 in left forelimb (9%). Nine cases came from Estado de México, 2 from Mexico City and 1 from Hidalgo. Initial manifestations included blisters (five cases), edema and erythema (three cases), liveloide plate (three cases) and necrosis (one case). Nine (75%) patients were initially managed in ICU. Systemic complications were renal (67%), lung with use of amines (33%) and hematological (8%). Ten cases were treated with fabotherapy, with an average of 1.5 vials (0-4). Five cases (42%) received dapsone and 4 of them (33%) developed methemoglobinemia. Eleven (92%) required surgical washing and debridement and 7 (58%) skin graft; four patients (33%) had secondary wound infection. Average hospital stay was 16.2 days (3-40 days).
CONCLUSIONS:
The evolution and prognosis depends on initial suspicion early diagnosis and treatment. Loxoscelism should be included in the differential diagnosis of progressive necrotic lesions, with or without systemic involvement.
Palabras llave : loxoscelism; dermonecrotic; systemic; sphingomyelinase-D; fabotherapy.