CASE REPORT Aural involvement in loxoscelism: Case report and literature review Sreekrishna Kanth Donepudi a , Khwaja Asif Ahmed a , Rose Mary S. Stocks a, * , Deborah Nelson b , Jerome W. Thompson a a Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 956 Court Ave., Room B216, Memphis, TN 38163, USA b Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA Received 20 March 2005; accepted 5 April 2005 1. Introduction The bite of the Loxosceles reclusa (or brown recluse) spider is one cause of a dermonecrotic lesion, espe- cially if encountered in the endemic region consist- ing of the Southern and Midwestern United States. The brown recluse spider measures 8—9 mm with a leg span of 5 cm. The creature can be identified by either the violin shape on the dorsal surface of its cephalothorax or its unique feature of having three pairs of eyes as opposed to two rows of four eyes each (Fig. 1). As the name suggests, this ‘‘shy’’ spider only bites in self-defense, typically when disturbed in a storage area, trapped under clothing, or rolled onto while in bed [1]. In 2001, there were 10,000 possible spider bites in the United States, 2566 of which were thought to be Loxosceles envenomations. One hundred of these patients required hospitalization or further intervention [2]. The sequelae of the brown recluse spider bite ranges from itching to dissemi- nated intravascular coagulation (DIC) and death [3]. Systemic loxoscelism is a condition that devel- ops in approximately 25% of cases and is charac- terized by one or more of the following: nausea, vomiting, chills, fever, myalgias, generalized pur- puric rash, thrombocytopenia, hemolytic anemia, acute renal failure, DIC, shock, coma, and death [4]. This severe subset of clinical presentations is more common in children, possibly due to a greater International Journal of Pediatric Otorhinolaryngology (2005) 69, 1559—1561 www.elsevier.com/locate/ijporl KEYWORDS Loxoscelism; Brown recluse; Hemolytic anemia; Proteinuria Summary An 11-year-old male presented with fever, rash, and a necrotic lesion on the lobule of the left ear. The lesion became tender and formed an eschar over 4 days. The patient developed leukocytosis, hemolytic anemia, and proteinuria, and was diagnosed with systemic loxoscelism from a brown recluse spider bite. He was managed with supportive therapy and improved in 4 days. Loxoscelism is a clinical diagnosis which should be suspected in an otherwise healthy patient with a necrotic wound, particulary in the endemic Southern and Midwestern United States. Physicians should be aware of this disease entity and its complications. # 2005 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +1 901 448 5885; fax: +1 901 448 5120. E-mail address: rstocks@utmem.edu (R.M.S. Stocks). 0165-5876/$ — see front matter # 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2005.04.015