In the first known case of its kind, a Michigan man developed recurrent deep vein thrombosis (DVT) in both legs after a reported bite from a brown recluse spider.
So far, “no case of deep vein thrombosis following a brown recluse spider bite has been described,” according to a new report on this unusual case published in April in the journal Clinical Case Reports.
brown recluse spider(Loxosceles recluse) is not commonly found in Michigan. However, occasional isolated populations have been identified in the state, and some studies suggest that arachnids may spread north of their native range as the planet warms.
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These solid brown, six-eyed spiders are believed to be native to Kansas, Oklahoma, Texas, Louisiana, Arkansas, Missouri, Mississippi, and Alabama, as well as Georgia, Tennessee, Kentucky, Ohio, Indiana, Illinois, Iowa, and Nebraska. ,
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In the new report, a 45-year-old man presented to the Michigan Emergency Department after being bitten by a brown recluse. (The case report does not describe how the spider’s identity was verified, but in either case there is no medical evidence available to definitively identify a brown recluse bite.)
The man was suffering from pain in his left calf as well as swelling and ulcers around the site of the bite. While examining the patient, the doctors also noted swelling, tenderness, and fluid buildup (known as edema) in the right calf. Based on the results of various tests, doctors made a tentative diagnosis of DVT and treated the man with saline, morphine and a drug to prevent blood clots.
When pain and swelling persisted, he underwent balloon thrombectomy, surgery to physically remove blood clots, and stents placed in several affected veins. He was then discharged home and given various medicines to reduce the chances of his blood clotting.
However, the man was “non-compliant with his medication” and returned to the emergency department four days later with discoloration, mild swelling, and worsening pain in his leg, wrote the authors of the case report. Another thrombectomy was performed and advised to continue with anticoagulant medication.
At a follow-up visit the following month, “she complained of persistent pain and swelling in her legs despite taking medication” and was treated with venoplasty, a procedure that uses a small balloon to help open a narrowed vein. . But a month later, symptoms persisted, and shortly thereafter, patients presented to the emergency room with an acute episode of leg swelling and pain, according to the authors.
He was then referred to a venous thromboembolism clinic, where doctors discovered scar tissue in the patient’s veins that contributed to the persistence of his symptoms. After that visit, the patient was advised to take blood-thinning medications for life and to wear compression stockings and a compression pump to relieve symptoms, the authors wrote. They were then lost to follow-up, so long-term data are not available.
How could the bite of a brown recluse spider trigger such a frequent DVT? The study authors suggest that a molecule called phospholipase D (PLD) present in the spider’s venom may have partly driven the development of the disease. PLD has been linked to “massive inflammation” and a build-up of platelets, the cell fragments that clump together to form blood clots.
“In our patient, we did not find any other cause that could have contributed to DVT,” the authors wrote. “Therefore, PLD can be attributed to the development of deep vein thrombosis.”
Live Science previously reported that brown recluse bites can cause mild to severe symptoms. Most bites cause swelling, but they eventually heal on their own. However, in people sensitized to the spider’s venom, bites can cause rapid death of skin cells and the development of circular “necrotic lesions” that sometimes persist for months.
In rare and especially severe cases, brown recluse bites can cause systemic loxoxalism, a body-wide immune response that can lead to blood clotting and destruction of red blood cells.
