Of spiders and zebras: publication of inadequately documented loxoscelism case reports

The dermatology and general medical literature is filled with articles that report skin disease caused by the brown recluse spider, Loxosceles reclusa. A large number of these articles contain inadequate documentation of Loxosceles bites; many come from areas that have no Loxosceles spiders. Authors submitting papers alleging loxoscelism should adhere to standards of evidence when writing case reports.

Reports of presumptive brown recluse spider bites reinforce improbable diagnosis in regions of North America where the spider is not endemic

Envenomations by the brown recluse spider have been reported throughout North America, despite the fact that the spider's range is limited to the South and central Midwest of the United States. Several of these medical reports have originated from regions of nonendemicity where the spider has never or rarely been documented and brown recluse spider populations are unknown. In most of these reports, no spider is positively identified in association with the dermonecrotic wound, and diagnosis has been based on clinical examination findings. Considering the extreme rarity of brown recluse spiders in areas of nonendemicity, the diagnosis of a presumptive bite is a misdiagnosis that reinforces the assumption that brown recluse spiders are common local etiologic agents of necrosis. There are many medical conditions of diverse origin that have been misdiagnosed as brown recluse spider bites, some of which can be fatal or debilitating. Physicians' awareness of these conditions will increase diagnostic accuracy in areas of North America where bites from brown recluse spiders are improbable.