Spider Bite

Spider Bite with Secondary Bullous Necrotizing Faciitis
© 2008 by Seth A. Rubenstein, D.P.M.

This 36 year old male was seen on hospital consultation with a history of a spider bite on the dorsum of his left foot 10 days prior. He noted progressive swelling and pain with systemic fever and chills and was initially treated with oral antibiotics (Augmnetin) by his PCP. Due to progressive pain and swelling he was admitted to the hospital 4 days prior to my initial exam. Treatment with IV antibiotics (Daptomycin, Clindamycin and Zosyn) had no clinical effect. Past medical history was remarkable for asthma. His swelling and redness was soon complicated by development of large bullae. (Fig. 1).

Fig. 1

The patient was brought to the operating room where debridement of the bullae and simple I&D was performed. The foot had profound swelling. The dorsal skin had an atypical soft texture about the spider bite region but bleed freely. No overt subcutaneous purulence was noted. For this reason, he was spared an aggressive debridement. (Fig. 2).

Fig. 2

Over the next 3 days, the skin overriding the spider bite site began to develop necrosis and remain soft, as if the subcutaneous tissue were liquefying. (Fig. 3). He was brought back to the operating room for aggressive debridement. The subcutaneous tissue was found to have poor quality, almost liquefied, this underlying the soft skin. Again, no overt purulence was noted (Fig. 4).

Fig. 3

Fig. 4

Following surgery, IV antibiotics were continued for 10 days and then switched over to oral antibiotics for 3 weeks. A wound VAC was applied for 1 month after surgery with good clinical response. (Fig.5). The wound was allowed to heal in by secondary intention. Final closure was documented 3 months after the initial procedure. (Fig. 6).

Fig. 5

Fig. 6