Loxosceles: A case healed completely without any necrotic tissue by emergency department and review of the literature
Yükleniyor...
Tarih
2013
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Loxosceles ısırığında görülen en sık bulgu ısırık yerinde progresif ülsere dermonekrozdur. Sphingomyelinase D zehirdeki asıl dermonekrotik faktördür. Zehir küçük kapillerlerde doku nekrozu başlangıcı olan hızlı koagülasyon ve oklüzyona neden olarak etkisini gösterir. 28 yaşında kadın hasta, sabah ayakkabısını giymeye çalışırken kahverengi bir örümcek tarafından ısırılmasından 3-4 saat sonra kliniğimize başvurdu. Sağ ikinci parmak iç proksimalinde lokal minimal inflamasyondan başka bulgusu yoktu. Ertesi gün gelen hastada ayak bileğine kadar orta derecede ödem, ısırık yerinden başlayarak proksimale ilerleyen sınırları net olmayan palpasyonla ısı artışı ve geniş kırmızı-mor cilt lezyonu mevcuttu. Hospitalizasyonun ilk günü CBCde RDW 15,50, lökosit 11,20, nötrofil %79,80, lenfosit %11,30, CRP 16, ABKda CPK 455, LDH 78, se- dimantasyon, PT, PTZ, kan gazı parametreleri normal sınırlarda idi. Ayak düz filmi çekildi. Ayak stabilizasyon ve elevasyonu sağlandı. Loxosceles zehirlenmesi öntanısıyla Acil Tıp adına 5 gün hospitalize edildi. Hospitalizasyonda sıvı replasmanı, antibiyotik, kortikosteroid, antiinflamatuar ile konservatif tedavi başlandı. Dördüncü hafta hafif pigmente cilt bulgusu dışında doku nekrozuna ait komplikasyon gelişmeksizin iyileşme sağlandı. Böcek sokmaları ile ilk anlarda belirgin bir şikayet ve bulgu olmaması klinisyeni yanıltmamalıdır. Bu hastaların izlemi ve kontrole çağrılmasının ciddi komplikasyonlar ve atlanabi- lecek olgularda önemi açıktır. (JAEM 2013; 12: 101-4)
The most common finding of Loxosceles biting is a progresive ulcerous dermanecrosis. The responsible dermonecrotic factor found in the venom is Sphingomyelinase D. Poison effects are indicated by coagulation and occlusion which are the initial triggers of tissue necrosis in small capillaries. A 28 year old female patient was admitted after being bitten by a brown spider 3-4 hours earlier while putting on her shoes in the morning. There was a finding wit t a local inflammation on the medial proximal part of the right second toe. The following day, there was a medium grade edema reaching to the ankle, a large lesion colored in red-purple with undetermined borders and increased temperature on palpation. On the first day of hospitalization, RDW was 15.50, WBC was 11.20, neutrophil was 79.80%, lymphocyte was 11.30% on CBC, CRP was16, CPK was 455, LDH was 78 whereas the parameters of sedimentation, PT, PTT, blood gas were in normal ranges. An x-ray of the foot was taken. Stabilization and elevation of the extremity were provided. She was hospitalized due to Loxosceles poisoning in the Emergency Department for 5 days. The conservative treatment with fluid, antibiotics, corticosteroid, antiinflamatory drugs were initiated. The foot healed with a minimal pigmented dermal finding without any complication of tissue necrosis on the fourth week. The patient without any significant initial complaints and findings in insect bites should not confuse the clinician. The importance of observation of these patients is clear for control of probable complications and misdiagnosis cases. (JAEM 2013; 12: 101-4)
The most common finding of Loxosceles biting is a progresive ulcerous dermanecrosis. The responsible dermonecrotic factor found in the venom is Sphingomyelinase D. Poison effects are indicated by coagulation and occlusion which are the initial triggers of tissue necrosis in small capillaries. A 28 year old female patient was admitted after being bitten by a brown spider 3-4 hours earlier while putting on her shoes in the morning. There was a finding wit t a local inflammation on the medial proximal part of the right second toe. The following day, there was a medium grade edema reaching to the ankle, a large lesion colored in red-purple with undetermined borders and increased temperature on palpation. On the first day of hospitalization, RDW was 15.50, WBC was 11.20, neutrophil was 79.80%, lymphocyte was 11.30% on CBC, CRP was16, CPK was 455, LDH was 78 whereas the parameters of sedimentation, PT, PTT, blood gas were in normal ranges. An x-ray of the foot was taken. Stabilization and elevation of the extremity were provided. She was hospitalized due to Loxosceles poisoning in the Emergency Department for 5 days. The conservative treatment with fluid, antibiotics, corticosteroid, antiinflamatory drugs were initiated. The foot healed with a minimal pigmented dermal finding without any complication of tissue necrosis on the fourth week. The patient without any significant initial complaints and findings in insect bites should not confuse the clinician. The importance of observation of these patients is clear for control of probable complications and misdiagnosis cases. (JAEM 2013; 12: 101-4)
Açıklama
Anahtar Kelimeler
Acil Tıp
Kaynak
Akademik Acil Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
12
Sayı
2
Künye
Gülalp, B., Emre, A. K., Altınörs, M. N., Sancak, Z., Yiğit, N. (2013). Loxosceles: A case healed completely without any necrotic tissue by emergency department and review of the literature. Akademik Acil Tıp Dergisi, 12(2), 101 - 104.
