Treatment of pediatric black widow spider envenomation: A national poison center's experience

Silently Suffering: A Pediatric Black Widow Spider Envenomation

BACKGROUND

Black widow spiders are distributed worldwide and, although rarely fatal, account for significant morbidity. Diagnosis can be challenging, and children are at risk of increased morbidity due to their small size.

CASE REPORT

We present a case of a 3-year-old boy who was brought to our emergency department because of sudden ear pain followed by labored breathing, abdominal pain, refusal or inability to speak, and grunting respirations. A black widow spider bite was suspected based on additional history obtained, and the spider was found in his helmet, confirming the diagnosis. The patient had progressive respiratory distress and somnolence and was intubated and transferred to a local pediatric intensive care unit. Antivenom was not initially available and eventually declined by the family. The child received supportive care and recovered after several days. Why Should an Emergency Physician Be Aware of This? This case illustrates the potentially deadly effects a black widow envenomation could cause in a child, and that bite location can affect the constellation of symptoms. It is a reminder that toxins, including that of the black widow spider, should be on the differential for acute abdominal pain, especially with autonomic features.

A case of pediatric northern black widow spider (Latrodectus variolus) bite in New York, USA

Black widow spiders (Latrodectus spp.) are generally perceived as inhabiting southern or western United States. However, some species, such as the northern black widow, Latrodectus variolus, are also found in more temperate regions of USA and adjacent Canada. This species also appears to expand its range northward with the climate change increasing the risk of human encounters. To our knowledge, this is the first case report of a pediatric envenomation from a northern black widow bite in northeastern US. Medical practitioners often fail to recognize the signs and symptoms of latrodectism delaying effective treatment. Even in more northern locales, healthcare workers should take black widow spider envenomation under consideration in the differential diagnosis particularly with suspected exposure.