Last night I had a patient who suffered a Brown Recluse bite (seems to be verified? back in August. He was initially treated with antivenin, abx, and removal of necrotic tissue.
Well he's now on my floor and has cellulitis throughout his ENTIRE left leg. They've cultured the wound and given him a dose of vanco, plus he's on q8hr zosyn.
The wound is about a quarter round, depressed with solid, dark dark red surface. The doc wanted it open to air for now. His temp was 39 overnight, I hope they can save his leg. Last CT ruled out Necrotizing fasciitis.
My question is, what is the wound surface that is hardish....looks like it crusted over like a soup might if you didn't stir it. Is that eschar or like dried blister? How'd they get a culture if it's dry like that?
I work nights so I don't get to talk to the ID docs as I would during the day. Just wonder if any of you could explain.
Mar 7, '06
I was unlucky enough to suffer the same thing- had a brown recluse bite me on the inside of my right ankle. Mine became round, open, a little larger than a quarter. When bandaged it became soupy but if left open to air it hardened as you have described. Just a guess, but I'd guess that they cultured it after it had been bandaged for a while, then left it open to air to dry. I ended up having surgery to remove the whole plug of skin including the ulcerated lesion from the bite, and it's healed fine since.
Mar 7, '06
Lori, what an ordeal!!
It sounds exactly as you described. Brown Recluses are endemic where you are aren't they? They weren't here but I think they've set up shop...
Mar 8, '06
Yes, I learned the hard way that there are lots of them around here. Funny thing is, I never felt the bite. I first noticed what looked like a perfectly round bruise and thought I had bumped it against something. Within a week or so it had turned black, then seemed to lighten to grey but when I looked close it only looked that way because there were thousands of "pinholes" going straight down into my flesh. Then the whole top sloughed off and there was a deep hole there that was oozing and painful. I tried to heal it myself, but one day when I washed it out I saw bone. That day I went to a doctor who berated me for not going sooner ("Why is it that no nurse comes to me with something simple, just when they let it get BAD?!?!" is what he said). He scheduled me for surgery the next week.
Mar 9, '06
Has anyone else gone through one of these bites? Was my experience and reaction typical?
Mar 9, '06
Go to medscape and do a search. They had a great article on this problem within the last week.